contents
5 Melody for Health 7 Our Own Journey to Good Health 5 9 Molar Pregnancy 12 Colorectal Cancer: 'Di Malayo sa Bituka 15 Additional Benefit of Bilateral Tubal Ligation 17 16 NAPC's New Sectoral Representatives 17 Outstanding Healthy Lifestyle Advocacy Awards 22 Bloomberg Awards for Global Tobacco Control 25 Tobacco-Free Metro Manila Film Festival 33 The Abaya Sin Tax Bill 37 Why Nicotine is So Addictive 39 The Air Pollution That We Breathe 42 Healthy Lifestyle: Banat ni Lolo, Hirit ni Lola 45 Trigger Finger 48 The "Crack" Epidemic jokes n'yo 25 33 stress RELIEF 24 laughter HEALS 32 FACEbeat 44 SAbeat 50
48 March - April 2012 I HEALTHbeat 3 DEPARTMENT OF HEALTH - National Center for Health Promotion 2F Bldg. 18, San Lazaro Compound, Sta. Cruz, Manila 1003, Philippines HEALTHbeat Tel. No. (63-2) 743-8438 Email: [email protected] Legislators, Please...
Legislators. They are the politicians elected by the people to write and pass laws that would commit to the common good. In a political system that recognizes the theory of the separation of powers, legislators are different individuals from the members of the executive and the judiciary.
We are currently witnessing how the members of the House of Representatives file an impeachment suit against Chief Justice Renato Corona and how the members of the Senate serve as judges in the trial. If this political exercise has become a media spectacular which has turned into a soap opera or even a comedy of manners, we cannot put the blame on our legislators. Let us not forget that we live in a society with a culture that everything, including the impeachment trial, is “more fun in the Philippines!”
Last February, Congressman Aurelio Gonzales Jr. has filed a House Resolution formalizing the appeal that seeks to put an end to the negative image of congressmen as seen in movies and television shows. He said the bad portrayals have been unfair and have only tainted the names of Editorial Board House members. Following this line, we can hope that legislators too would put a stop in showing Ivanhoe C. Escartin, MD tobacco use in all forms of media that would entice the youth to smoking. Rosemarie G. Aguirre
Legislations can reverse the tobacco epidemic. Aside from the ban on advertising, promotion and Editors-in Chief Anthony R. Roda sponsorship of tobacco products, laws are also needed to effect smokefree public places to protect May Elenor R. de Guzman the public from exposure to secondhand smoke; putting graphic health warnings on cigarette Managing Editor Donato Dennis B. Magat packs to encourage smokers to quit; and taxation to increase the price of tobacco products. Staff Writers Elizabeth G. Mascareňas Taxation is the single most effective way to reduce tobacco consumption, that is why the Abigail Corpuz-Quetulio Department of Health needs our legislators to pass House Bill No. 5727, penned by Cavite Glen S. Ramos Representative Joseph Emilio Abaya. This is the most fitting among the 12 pending measures in Cover Design Diosdado G. Angeles, Jr. Congress seeking to restructure the excise tax on alcohol and tobacco products. It moves from a multi-tiered tax structure to a unitary tax system, indexes taxes to inflation and dedicates taxes Graphics Design Joerem P. Ceria to alternative livelihood for tobacco farmers and universal health coverage in PhilHealth and to Jacquelyn F. Felipe enhance the nation’s health care system by upgrading government health facilities to provide Photographer Paquito P. Repelente better health services. Contributors Honorable Legislators, please pass the necessary tobacco control laws that would protect the (Words) Elizabeth Sumama, MD health of the youth and the majority of the population who are non-smokers. This common good Tato M. Usman, MD is in your hands! Circulation DOH-NCHP Production, Dissemination – The Editors and Collection Section
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4 HEALTHbeat I March - April 2012 COVER story
Pop Diva Kuh Ledesma (right) and daughter Isabella (right) sing the DOH safe motherhood jingle, "Sa Health Center, Suportado Ka. Punta Na!" (Photo by Paking Repelente) Melody for Health The Department of Health is of Japan, administers Japan’s Official MCH Project aims to provide assistance intensifying its effort to reduce maternal and Development Assistance (ODA) programs in through provision of essential medical child mortality as part of its commitment to the form of technical cooperation, grant aid equipment, capacity building of health achieve Millennium Development Goals 4 and loan. There are about 100 JICA overseas service providers, institutionalization of and 5 and Kalusugan Pangkalahatan offices (including the Philippines). Today, it is the Community Health Teams (CHTs), and (Universal Health Care). Together with advancing its activities around the pillars of a strengthening of partnerships among local the Local Government Units (LGUs) of field-oriented approach and human security, stakeholders for increased support for Eastern Visayas and the Japan International with emphasis on effectiveness, efficiency, improved MCH services. Cooperation Agency (JICA), the DOH is and speed. JICA’s vision of "inclusive Now on its second year, the Project stepping up the Strengthening Maternal development" represents an approach to has been received well. A gradual increase in and Child Health Services Project which development that encourages all people use of MCH services at these health facilities seeks to enhance the capacities of health to recognize the development issues they has been observed and this contributed centers in the Eastern Visayas in delivering themselves face, participate in addressing largely in making pregnancy and childbirth maternal and child health (MCH) services. them, and enjoy the fruits of such endeavors. in Eastern Visayas safer. With the National JICA, a governmental agency In particular, the JICA-supported Safe Motherhood Program now in full
March - April 2012 I HEALTHbeat 5 implementation, the DOH is just like the Health radio jingle – a song that delivers a “Sa Health Center, Suportado Ka. excited “expecting parents” waiting for their message of passion and love. Punta Na!” baby project to be fully delivered. Kuh, known for her rendition of Chorus “Sa Health Center, Suportado “Ako ay Pilipino” among others, is not just a Kuh: Sa Health Center Ka” is the key message of the DOH's new singer but is a person with a golden heart. Isabella: Punta na... radio jingle to promote its national safe Unknown to many, she is an advocate Kuh: Panganganak mo’y sigurado motherhood program. Originally produced in uplifting the lives of underprivileged Isabella: Sa Health Center Kuh: Punta na... in Eastern Visayas, the song encourages children. She is currently raising funds to Isabella: Ika’y ligtas at protektado. pregnant women to visit health centers to set-up libraries and church buildings which Verse 1 avail of pre-natal care consultations, worry- will benefit several communities in Cavite. Kuh: Pagmalaman mong ika’y free delivery and postpartum care with the Isabella, meanwhile is a young buntis magpa-check up support of the CHTs. lady with a lot of promise. Not only did she kaagad sa Health Center Isabella: Nang apat na beses bago Pre-natal visits have been shown get her mother’s looks, she also got her magsilang para kumplikasyon to reduce the risk of maternal deaths and to mother’s musical talent and her compassion. ay maiwasan. improve over-all maternal and child health. She uses her talents in singing and acting Repeat Chorus Now that health centers are equipped with to share messages of life and love to many Verse 2 the proper equipment and are manned by people. Kuh: Pagkatapos mong manganak punta na uli sa health center competent health workers, Filipino mothers It is just fitting that the mother Isabella: Para makasiguro at mapanatili and their babies will be provided quality and daughter tandem of Kuh and Isabella ang kalusugan mo at ni baby. health in these facilities, true to the promise sing this song which encourages mothers Repeat Chorus of the jingle, “Sa Health Center, Suportado Ka. to seek proper health care in health centers Together: Kaya laging tandaan Punta Na!” so they can be assured of the support they Sa Health Center, Suportado ka! Pop Diva Kuh Ledesma and her need for their health and the health of their Punta Na! daughter Isabella lent their talents to give families. the soul to the DOH Maternal and Child - o O o -
The "Pomelo Squad" of the DOH National Center for Health Promotion poses with Kuh and Isabella during the media launch of the jingle.
6 HEALTHbeat I March - April 2012 HEALTH promotion
Governor Esmael Toto Mangudadatu (right) gives vitamin A drops to a child. Assisting him are DOH ARMM Secretary Kadil Sinolinding (left) and Provincial Health Officer I Dr. Elizabeth Samama. (©USAID/HealthPRO/Nancy Pizarro/2011) First Person Account: Our Own Journey to Good Health by DR. ELIZABETH SUMAMA Maguindanao Provincial Health Office
Little did I know that the beads Bring a mobile bus to a disadvantaged our Governor Toto Mangudadatu. He quickly of sweat on our foreheads would form community and deliver health services and approved it saying that health is a big priority ripples of change in our beloved province of information to as many mothers, fathers, for his administration. Maguindanao. and children as possible. Impossible! I first Thus began our own LBK journey. When we first heard about the said to myself. It was difficult at first. We had to meet with Department of Health’s Lakbay Buhay Dr. Kadil Sinolinding Jr, our DOH different partners to get their support. We Kalusugan, we really got nervous. It was an ARMM secretary, and Dr. Tahir B. Sulaik, went to the town of Buluan, spoke to Mayor undertaking that we thought we could not Maguindanao Provincial Health Officer II, Datu Ibrahim Mangudadatu, and got his do in Maguindanao. guided us and convinced us that LBK can be approval to host LBK. I thought that it was a tall order. done in Maguindanao. We presented LBK to On October 10, 2011, the colorful
March - April 2012 I HEALTHbeat 7 bus came and our own health fiesta health for our people without the heroic the action of LBK. But we also could not started. It was tiring but we did not mind efforts of our unsung heroes – our health do it if not for the generous support of our the hardship because we saw so many workers.” other partners. Together, we made ripples mothers, fathers, and their children enjoying To my team: Municipal Health of change because we all wanted the same and participating. We never imagined that Officers Dr. Renalyn Masukat and Dr. thing – provide universal access to quality we would be able to serve 3,740 people, Tina Almirante, our public health nurses, health care to all people of Maguindanao. including 361 pregnant women and 722 midwives, and barangay health workers, I Our journey has just started. It’s children in just two days. say it was a job well done. still a long way to go for us. But it’s a trip we Through the collective efforts To the DOH and development will gladly take and remember. and participative support of all major partners like the US Agency for International And LBK’s message is heard so stakeholders, we have made an impossibility Development (USAID), thank you for putting clearly in Maguindanao. “Walang iwanan sa into a very wonderful and promising health your trust in us. biyaheng kalusugan!” promotion caravan. Yes, we were in the midst of all - o O o - But I did not expect that our LBK journey would continue. Our local leaders, mindful of the lack of adequate information and education as one of the one major factors that prevent access to available health services, appreciated LBK so much that they decided to launch our local version of LBK. We called it the SLAM Mobile Health Festival. SLAM stands for the Southern Liguasan Alliance of Municipalities. The alliance is composed of other towns like Datu Paglas, Paglat, General Salipada K. Pendatun, Sultan sa Barongis, and Pagalungan. The honorable mayors of these towns joined hands and agreed to bring the LBK health caravan to different communities. On February 23, we made our first stop in Datu Paglas where more than 1,000 fathers, mothers, and children participated in fun activities and health classes. Other health services like dental care, circumcision and minor surgery, handwashing program, reflexology and even free haircuts were added to the roster of activities. The SLAM mayors also agreed to customize a mobile vehicle that would serve as the SLAM LBK vehicle. For a health professional like me, it was very heart-warming to hear local leaders pledge their support to our health TOP: “Beads of sweat form ripples of change.” Dr. Elizabeth Samama (left) presents the Maguindanao programs. Mayor Mohammad Paglas said it LBK experience at a lessons learned meeting in December 2011. BOTTOM: Pregnant women line up for so fittingly, “We could not achieve optimal their pre-natal check up at the LBK bus. (©USAID/HealthPRO/Nancy Pizarro/2011)
8 HEALTHbeat I March - April 2012 maternal HEALTH
MOLAR PREGNANCY where a fertilized egg does not develop into a pregnancy but instead grows and forms into a bunch of grape-like shapes. Photo grabbed from
March - April 2012 I HEALTHbeat 9 a molar pregnancy, the wrong number of x of grapes that can be seen through an making the uterus to expand. The developing and y chromosomes come together which ultrasound scan. In partial molar pregnancy, placenta pushes up the levels of the hCG, results in abnormalities in cells that grow to the fertilized egg has 23 chromosomes from which makes her so nauseous. form the placenta. The two chromosomes in the mother but a duplicated set from the “But actually, it is not the embryo the fertilized egg (i.e. molar chromosomes) father (there are a total of 69 chromosomes that is growing but the neoplasm which directly come from the male only. The instead of the normal 46 and this can is replacing the true embryo. This will significant abnormality of this clinical happen when chromosomes from the sperm eventually turn into a tumor and which condition is that the molar chromosomes are are copied or when two sperm fertilize the should immediately be removed,” she entirely derived from the father. Its cause is same egg). confirmed. still unknown. A complete molar pregnancy can Bleeding during a molar pregnancy Baret identified two distinct be detected by using an ultrasound scan may also occur and it may vary. It could be types of molar pregnancy – complete and during the early stage of pregnancy. The bright red or dark brown, continuous or partial. In a complete molar pregnancy, the levels of the hormone, human chorionic patchy, and light or heavy and it could start fertilized egg has no chromosomes from gonadotrophin (hCG) and also known as the as early as six weeks into the pregnancy or the mother and the chromosomes from the “pregnancy hormone,” will be much higher as late as 16 weeks. Although bleeding is father's sperm are duplicated (meaning, than normal. Measuring the hCG level with common in the early stage of pregnancy, it is there are two copies of chromosomes from a blood test is one way of finding out if the essential to visit the doctor to ascertain the the father). In this condition, it is not possible woman has a complete molar pregnancy. cause of the bleeding. for an embryo, amniotic sac and normal Levels can first be detected by a blood test The occurrence of molar pregnancy placenta to develop but instead the placenta about 11 days after conception and about is highest in teenage pregnancies, among forms a mass of cysts that looks like a cluster 12 - 14 days after conception by a urine test. women over 40 years old, those with history In general the hCG levels will double of molar pregnancies (especially two or every 72 hours. The level will reach more), those with history of miscarriage and its peak in the first 8 - 11 weeks of those with vitamin A deficiency (especially pregnancy and then will decline and betacarotene). level off for the remainder of the In the United States, molar pregnancy. pregnancy occurs in one out 1,500 Partial molar pregnancy is more pregnancies while the United Kingdom difficult to detect, especially if registers one in every 1,000. But in Asian it has not been seen on a scan. women, they are twice as common and the If the pregnancy ends naturally reason is yet to be discovered. In one of her before a scan, i.e. miscarriage, the researches, Baret found that two out of 80 woman may opt to have a test pregnancies in the Philippines are molar to verify whether it was a partial pregnancies, which is the highest rate of molar pregnancy. Samples of the occurrence worldwide. The distinct marked miscarried tissues will be analyzed geographical and ethnic variations in the to make sure the right treatment will prevalence of this condition are also very be provided. common in in China, Indonesia, Japan, India Baret explained that in a case Africa and Latin America. There is no definite of a molar pregnancy, all the reason behind molar pregnancy but some usual pregnancy symptoms will medical experts attribute this condition to Dr. Abigail Baret, an Obstetrician-Gynecologist and a be experienced. The woman will genetic factors, diet, and environment as resident physician at Talon General Hospital in the City of Tarlac explains that although molar pregnancy belongs feel severe nausea and vomiting probable influences. to a group of conditions called gestational trophoblastic (hyperemesis), her belly may swell At the Jecson’s Medical Hospital, tumors, it is usually not cancerous. up due to the growing placenta, another hospital in Tarlac, an incident of
10 HEALTHbeat I March - April 2012 molar preganancy was recorded in February cells be removed from the uterus wall rare form of cancer called “choriocarcinoma.” alone. The patient suffered from profuse because the cells can spread through the It is a quick-growing form of cancer that bleeding and complained of pains in the blood and may affect other organs, including occurs in a woman's uterus (womb). The pelvic region. the lungs, liver and brain. Further testing abnormal cells start in the tissue that would may be done to ensure that it hasn't spread normally become the placenta, the organ Symptoms Diagnosis & Treatment beyond your uterus. Even though molar cells that develops during pregnancy to feed the can spread, they are not cancerous and this fetus. Choriocarcinoma is an uncommon, but The symptoms of a molar condition has a cure rate of nearly 100 per very often curable cancer associated with pregnancy are the same with that of a normal cent. pregnancy. A baby may or may not develop pregnancy, like a missed period or morning in these types of pregnancy.) A chest X-ray, sickness. But it also causes other symptoms Gestational Trophoblastic Disease bloodwork, and other radiological exams that may include bleeding from the vagina, are done prior to D&C to determine if a an enlarged uterus, severe nausea and Approximately 90% of women molar pregnancy has metastasized (spread vomiting, signs of hyperthyroidism. who undergo this procedure require no to other parts of the body). This can also Other symptoms are feeling further treatment. A regular blood test will be successfully treated with chemotherapy. nervous or tired, having a fast or irregular be done over a period of 6 to 12 months to The condition occurs in one in 30,000 of all heartbeat, profuse sweating, a painful monitor the hCG levels and to look for signs pregnancies, including normal pregnancies feeling in the pelvic region, vaginal of gestational trophoblastic disease (GDT) and miscarriages. discharge of grape-shaped tissues (this is and to ensure that it will not develop after Baret assures women who have usually a sign of molar pregnancy). Most of the operation. had a molar pregnancy that they will still these indications can also happen during a According to Baret, “these blood have a chance of having a normal pregnancy normal pregnancy, a multiple pregnancy, or tests will make sure that the hCG levels next time. However, it is important to follow a miscarriage. are dropping, indicating that the patient your physician’s advice before trying to start Molar pregnancy can be diagnosed is getting better. Once the hCG levels are again. “For those who have undergone by a pelvic exam, an ultrasound and a blood normal, then it is a sign that no molar tissue chemotherapy, they will need to wait up test. A pelvic exam may reveal whether the is left. A follow-up is also done to ensure to six months or even a year. They need to woman has large or small uterus or enlarged that the mole has been completely removed have their hCG level back to normal because ovaries. A sonogram will show a “cluster of from the walls of the uterus. Traces of the if they become pregnant before all of these grapes” appearance, signifying an abnormal mole can begin to grow again and this may conditions are set to normal, they will have placenta. And a blood test will indicate an possess a cancerous-type threat to the body.” a greater chance of having another molar abnormally high amounts of the pregnancy GTD is a term used for a group of pregnancy- pregnancy,” she reiterated. hormone hCG. related tumors. These tumors are rare and Pregnancy should be avoided for A woman suffering from a appear when cells in the womb start to grow the period of one year. She recommends molar pregnancy may need a dilatation out of control. The cells that form gestational the use of birth control methods with the and curettage (D&C) or a minor operation trophoblastic tumors are called trophoblasts exception of an intrauterine device (IUD) commonly known as “raspa.” A surgeon and come from tissue that grows to form the until it is safe to try for another pregnancy. will carry out the D&C while asleep under placenta during a molar pregnancy. “Condoms can be used and pills, although I general anesthesia. In case a GDT may develop, there is do not recommend using pills especially if “Most molar pregnancies a minimal chance that it will turn into cancer. the hCG levels are still high,” she cautioned. naturally end and the grape-like tissues will And if this happens, chemotherapy is usually “The chances of having another eventually be expelled by the body. In some recommended so that it will not spread to molar pregnancy are very minimal, about cases, it is removed by suction curettage other parts of the body, or it will sometimes one or two per cent. When the woman (D&C) or sometimes through medication,” be combined with radiation treatment. is pregnant again, be sure to have an Baret explained. In very few cases, however, ultrasound scan in your first trimester to It is important that all the molar persistent GTD can lead to an extremely make sure all is well”, Dr. Baret concluded.
March - April 2012 I HEALTHbeat 11 CANCER awareness COLORECTAL CANCER 'Di Malayo sa Bituka by ELIZABETH G. MASCAREÑAS HEALTHbeat Staff Filipino's Most Vital Organ? The incidence of colorectal cancer globally is increasing in certain countries, where risk Think about this. For Filipinos, the was historically low, like in Japan. most vital part of the human body is not the Meanwhile, in high-risk/high- heart but the intestine. income countries, trends are either gradually Many of the rich, vivid and colorful increasing (Finland, Norway), stabilizing Filipino idiomatic expressions zero in the (France, Australia), or declining (United intestine – “magkakabit ang bituka” refers States) with time. The greatest increases in to a strong relationship bond; “halang the incidence of colorectal cancer are in Asia ang bituka” refers to very bad person; (Japan, Kuwait, Israel) and Eastern Europe and “huwag kang mag-alala, malayo (Czech Republic, Slovakia, Slovenia). yan sa bituka” usually refers to a non-life The ACS also stated that the threatening wound or condition. decrease in colorectal cancer incidence in the Even the folk belief concerning the United States partially reflects the increase aswang has its interest on the intestines; and in detection and removal of precancerous the life of a manananggal ends when salt is lesions, while the increase in several Asian placed on its exposed intestines in the lower and Eastern European countries may reflect half of the body that is left behind while the The large intestine. Photo grabbed from the changes in risk factors for colorectal cancer upper half is in flight looking for its victim. Internet. that are associated with westernization, And notice the modern Filipino psychic such as elevated obesity and smoking healers who concentrate their treatment on collectively known as colorectal cancer. Bad prevalence. the abdominal area. news, its cases are on the rise! In contrast to incidence trends, Life, so it seems, is focused on the The American Cancer Society (ACS), decreasing colorectal cancer mortality rates intestines, and most parts of the abdominal in its Global Facts and Figures, reported that have been observed in a large number of region. And why not, the continuance and an estimated 1.2 million cases of colorectal countries worldwide and are most likely sustenance of life is food. The availability of cancer worldwide occurred in 2008, wherein attributed to colorectal cancer screening food, or lack of it, becomes crucial to survival. the highest incidence rates were found in and/or improved treatments. However, And that Filipinos associate food with health North America, Australia, New Zealand, increases in mortality rates are still occurring is seen in rituals which always have food Europe, and Japan. However, rates were low in countries that have more limited offerings. in Africa and South Central Asia. It was noted resources, including Mexico and Brazil in Alas, the food we eat, the alcohol that rates were significantly higher in men South America and Romania and Russia in we drink, and the lifestyle we have may than in women. Eastern Europe, ACS stated. put this vital organ of the body at risk of In 2008, there were about 608,700 Health Secretary Enrique T. Ona, developing a serious disease – cancer of deaths from colorectal cancer worldwide, who led the observance of Colorectal Cancer the colon (large intestine) and rectum or which accounts for 8% of all cancer deaths. Awareness Month in March, announced that
12 HEALTHbeat I March - April 2012 the disease is more common in developing and 1,370 among females, in 2010. In gland cells that line the inside wall of the countries and in people aged 50 years and 2008, the estimated national standardized large intestine. above. In the Philippines, approximately mortality rates were 4.7 per 100,000 in both No one knows for sure what causes 5,787 Filipinos were affected by the disease sexes, 5.5 among males, and 3.9 among colorectal cancer. But there are certain in 2010 alone. females. risk factors that can increase a person's According to the Philippine Cancer chances of getting and dying from this type Facts and Estimates 2010, colorectal cancer Understanding Colorectal Cancer of cancer. Some risk factors for colorectal is the third most common cancer in men cancer cannot be controlled, such as having (3,208cases or 8% of all cancer sites) and With statistical figures on a family history of this cancer type, age and fourth among women (2,579 cases or 6%). It colorectal cancer continuing to increase, ethnicity. A person with a history of chronic was noted that the incidence rates begin to understanding the disease could be the first inflammatory bowel disease also has a suddenly rise at age 50 years in both males step to winning the battle against this type higher risk for developing colorectal cancer. and females. of cancer. However, some lifestyle habits that increase These figures were gathered from Colorectal cancer refers to the the risks may be managed, such as avoiding two population-based cancer registries, uncontrolled growth of abnormal cells in a diet high in animal fat and low in fiber, namely the Philippine Cancer Society - the colon or rectum, which are part of the inactive lifestyle with no exercise, drinking Manila Cancer Registry and the Department digestive system. Colorectal cancer is usually alcohol, obesity and smoking. of Health – Rizal Cancer Registry, which curable when it is detected in the early Colorectal cancer sometimes arises generated age-standardized incidence rates stages. Increased screening could further without any symptoms. When symptoms do of cancer during the period 1980-2002 where reduce the incidence and mortality rate of occur, they usually consist of the following: it showed rising trends in colorectal and colorectal cancer. rectal bleeding or blood in the stool; prostate cancers and became more common This cancer usually begins as change in bowel habits (such as diarrhea, than liver cancer with stable incidence over polyps, which are abnormal growths in the constipation) that lasts for more than a few time. inner lining of the colon or rectum. Polyps days; abdominal pain; a continuous feeling The highest incidence rates of are not cancerous but can become so over of need to have a bowel movement and body colon cancer among males was in 1998- the years. More than 95 percent of colorectal weakness. 2002 and were monitored in the cities of cancer is adenocarcinoma, a cancer of the Screening examinations for Mandaluyong, Parañaque, Manila and Quezon City, while the rest of Metro Manila and Rizal province had lower incidence rates. Among females, the highest incidence rates were in Parañaque, Quezon City and Manila, and also decreasing incidence rates eastward to Rizal province. Meanwhile, the highest incidence rates of rectum cancer among males in 1998-2002 were in Manila, Quezon City, and Parañaque, and in females the highest incidence rates were in Manila, Pasig and Quezon City. According to the two registries, one (1.2) out of 100 men and one (0.8) out of 100 women had a likelihood of getting Health Secretary Enrique T. Ona leads this year’s observance of Colorectal Cancer Awareness Month colorectal cancer before age 75. There were in March dubbed as “Kapit-Bisig Sa Paglaban Sa Colorectal Cancer.” This is in collaboration with the 3,060 deaths in both sexes, 1,690 in males Philippine Society of Medical Oncology and Merck Serono.
March - April 2012 I HEALTHbeat 13 colorectal cancer should start at age 50 years can also be considered for asymptomatic many physicians still insist on prescribing for average risk individuals who have not individuals. vitamin preparations and hematinics for yet shown symptoms. Persons at higher risk Possible indicators of the disease chronic unexplained weight loss and anemia should begin screening at a younger age and may include changes in bowel habits, without endeavoring to look for the cause. may need to be tested more frequently. abdominal pain and bleeding from the Dr Felycette Gay Lapus of the One of the most common rectum. However, screening for colorectal Philippine Society of Medical Oncology, diagnostic tests is annual fecal occult blood cancer is still an urgent step for individuals explained that the outlook for recovery testing, which can detect minute amounts of because symptoms may be absent or may be depends on the stage of cancer, meaning blood in the stool, even without noticeable caused by other conditions. the higher the stage, the more serious the gross blood. Other tests for colorectal cancer A person with these symptoms or disease. The five-year survival rate refers to include rectal digital examination; and consider him/herself at risk even without the the percentage of patients who live at least proctoscopy or proctosigmoidoscopy, which symptoms, may want to talk with a doctor five years after being diagnosed. Stage I refers to the examination of the lower end of who would be able to suggest ways to has a 74% five-year survival rate while the colon and rectum. reduce the chance of developing colorectal Stage IV has a five-year survival rate of only On the other hand, flexible cancer and plan an appropriate schedule for 6%. Recent advances and multi-modality sigmoidoscopy is an examination of the checkups. treatment has led to a greater potential for mucosal lining of the distal left colon and Public information and education cure rates for advanced disease, some with rectum. Colonoscopy or the examination of is important, as well as physician greater than 40% five-year survival rates. the entire colon may also be performed. It education. Delayed diagnosis of colorectal Anyone can suffer from colorectal does not only let doctors see the interior of cancer is often attributed to the mistaken cancer regardless of socio-economic status, the colon and rectum, but also allows them concentration of Filipino physicians with education or culture. In the list of famous to remove any polyps that may be growing. amoebiasis, other forms of infectious people diagnosed with the disease are: Pope Polyps can develop into cancer, thus, the bowel diseases, and hemorrhoids. The wide John Paul II, US President Ronald Regan, removal of these polyps can prevent cancer availability of antidiarrheals, antibiotics, and Milton Berle - American comedian, Audrey altogether. Ultrasound, blood tests, x-rays amoebicides also results in their prolonged Hepburn – actress, Charles Schulz - creator of and magnetic resonance imaging or MRI and sometimes dangerous use. Moreover, “Peanuts,” and President Corazon C. Aquino. spiritual HEALTH Hindi Kumplikado Ang Buhay Isang guro ng Pilosopiya ang nagbigay ng iisang tanong sa kanyang mga estudyante para sa kanilang Final Exam. Ang tanong ay, "Paano mo ako mapapaniwala na ang silya sa harap ninyo ay invisible?" Isang oras ang ginugol ng klase para sagutin ang tanong, maliban sa isang tamad na estudyante na tinapos ang pagsusulit sa loob lamang ng limang segundo. Kinabukasan, ipinaskil ng guro ang resulta ng Final Exam. Ang tamad na estudyanteng ito ang nakakuha ng pinakamataas na grado. Alam ba ninyo kung ano ang kanyang isinagot? "Anong silya?" ARAL: Huwag gawing kumplikado ang mga simpleng bagay.
14 HEALTHbeat I March - April 2012 RESEARCH brief
Navigating through the maze of information from medical research can be difficult and confusing. This brief aims to provide concise and evidence-based information on state-of-the-art medical practice. Additional Benefit of Bilateral Tubal Ligation: Prevention of Ovarian Cancer
Ovarian cancer is the seventh leading cause of cancer deaths among Existing evidence shows, however, that the risk of ovarian cancer is women in the Philippines. In 2010, an estimated 2,165 new cases of greatly reduced through bilateral tubal ligation (BTL). In this surgical ovarian cancer were diagnosed, and over 1,000 women died from this procedure, a woman’s fallopian tubes are cut to prevent the egg from disease nationwide.1 meeting the sperm. This method of contraception is a safe and effective family planning option for women who do not want any more children. As in most cancers, the cause of ovarian cancer is unknown, but risk Research confirms that women with BTL had reduced the risk of ovarian factors, including age over 40 years, nulliparity (state of not bearing an cancer by 34% with the protective effect lasting 10-14 years following offspring), and family history of breast and uterine (endometrial) cancers, the procedure.4 have already been identified.2 Several theories have been proposed to explain BTL’s protective effect Part of the reason why many regard ovarian cancer as a “silent killer” against ovarian cancer: is because it does not usually show symptoms at the outset.3 If it does, • Diminished ovarian circulation after TBL contributes to the these are nonspecific, minimal and often ambiguous. Lower back pain, suppression of ovarian hormone production; pain during intercourse, abnormal vaginal bleeding, irregular menstrual • Reduced utero-ovarian circulation by BTL leads to the decreased periods, and other symptoms such as abdominal pain, bloating, loss amount of uterine growth factors reaching the ovaries; of appetite, constipation, flatulence and frequent need to urinate, are • BTL may prevent the entry of carcinogens or talc into the sometimes confused with symptoms of other less severe diseases such fallopian tubes and contact with the ovaries as well.5 as gastrointestinal complaints. Late diagnosis is common because ovaries are difficult to access and examine. Tests to diagnose the disease, such BTL is one of many family planning options available in the Philippines. as pelvic ultrasound, laparoscopy, colonoscopy, blood test and biopsy, While knowledge among all women in the country about ligation is are still too costly to be part of a routine check-up for the general public. widespread, only 9% of married women of reproductive age rely on BTL Treatment options include surgery for patients with early stage ovarian as their method of choice.6 BTL costs 1,400 - 10,000 Php, depending on cancer, and chemotherapy for those in advanced stage. whether it was done in the public or private sector.7 PhilHealth members and dependents are entitled to a PhP4,000 reimbursement per case, subject to the provisions of the benefit package.8
In addition to BTL’s contraceptive benefits, information on how it protects against ovarian cancer should be shared by health service providers with women who have completed their family size and have signified their interest in long-acting and permanent methods of contraception.
1http://www.scribd.com/doc/80871630/11/REFERENCES. pp. 11, 13. 2http://www.doh.gov.ph/node/314 3Ibid. 4D. Cibula, M. Widschwendter, O. Májek and L. Dusek. Tubal ligation and the risk of ovarian cancer: review and meta-analysis Hum. Reprod. Update (2011) 17(1): 55-67 first published online July 15, 2010 doi: 10.1093/humupd/dmq030 5http://www.medinewsdirect.com/?p=996 6National Statistics Office Philippines and ICF Macro. 2009. National Demographic and Health Survey (NDHS) 2008. Calverton, Maryland: National Statistics Office and ICF Macro, pp. 51, 52, 54, 63, 66. 7Ibid, p. 62. 8http://www.philhealth.gov.ph/circulars/2008/circ16_2008.pdf (Photo: USAID/HealthPRO/Ignacio) (Photo:
March - April 2012 I HEALTHbeat 15 HEALTH partners NAPC's New Sectoral Representatives
The National Anti-Poverty the People's Credit and Finance Corporation Administrative Order No. 21 that returns to Commission (NAPC) is the government as the forerunners for microfinance services; the basic sectors the power to nominate their agency that coordinates poverty reduction and strengthening local government units representatives. He said that during the past programs of national and local governments so they can incorporate the SRA in their local years, many civil society organizations have and ensures that marginalized sectors development efforts. been disenfranchised from joining the NAPC participate in government decision-making President Benigno S. Aquino III process. AO 21 amended the implementing processes. chairs NAPC and is assisted by the Vice- rules and regulations of RA 8425 to push for NAPC was created by virtue of Chairperson for the Government Sector a more meaningful representation from the Republic Act (RA) 8425, otherwise known as (with 25 national government agencies basic sectors. the "Social Reform and Poverty Alleviation and presidents of the four leagues of local On January 22, the Palace released Act," which took effect on 30 June 1998. governments as members) and another Aquino's latest appointments and named Its specific mandates include: acting as the Vice-Chairperson for the Basic Sectors the new NAPC sectoral representatives, coordinating and advisory body that exercises (with representatives from the 14 basic including Engr. Emerito "Emer" Rojas oversight functions in implementing the sectors as members). NAPC is supported by (staunch anti-tobacco advocate and the social reform agenda (SRA) and ensure that a Secretariat, which is currently headed by cover of Healthbeat's September-October it is incorporated into the formulation of Lead Convenor Joel M. Rocamora. 2011 issue) for persons with disabilities. national, regional, sub-regional and local During the National Sectoral He is a tobacco victim who lost his voice to development plans; institutionalizing basic Assemblies held on October 17-19 2011, laryngeal cancer. sector and non-government participation Aquino has imposed a new set of criteria for (See photo for the complete list of in managing the SRA cycle; developing sectoral representatives who can participate the sectoral representatives.) microfinance programs and strengthening in the assemblies of the NAPC. He issued - o O o -
LEFT: NAPC SECTORAL REPRESENTATIVES. Front row from left to right: Gloria Madayag (workers in the informal sector); Marilou Tapia (farmers and landless rural workers); Teresa Fernandez (women); Maria Cagay (victims of disasters and calamities); Maria Linda Paracuelles (urban poor); Norisa Saberin (children); and Delfa Talaid (artisanal fisherfolk). Back row from left to right: Gibby Gorres (youth and students); Marlon Manuel (NGOs); Emmanuel Villafuerte (senior citizens); Secretary Jose Eliseo Rocamora (NAPC lead convenor); Emer Rojas (persons with disability); Ponyong Kadlos (indigenous cultural communities/ peoples); and Daniel Ang (cooperatives). RIGHT: Engr. Emer Rojas (staunch anti-tobacco advocate and the cover of Healthbeat's September-October 2011 issue) during his oathtaking as sectoral representative for persons with disabilities.
16 HEALTHbeat I March - April 2012 HEALTH lifestyle OHLAA Outstanding Healthy Lifestyle Advocacy Awards
The Poor Dies Early preventable biological risk factors – high blood pressure, high blood "Only the good die cholesterol, overweight; and by young," says a Billy Joel song in related major behavioral risk factors 1977. But maybe not anymore. – unhealthy diet and nutrition, International media reported in physical inactivity, tobacco, alcohol February the results of a longevity and drug use. study in United Kingdom that showed that the wealthiest people Advocating Healthy Lifestyle live longer than the poor. This is not a pioneering study, but many of this Over at the Department of kind of study in other countries had Health, officials are trying very hard the same results. The World Health to reduce risk factors and create Organization (WHO) has stated that health-promoting environments as "people further down the social well as strengthen national policies ladder usually run at least twice the and health systems. That is why risk of serious illness and premature the prevention and control of NCDs death of those near the top." Healthy Lifestyle is about getting the right proportions. (Photo grabbed now becomes an important part The reason why poorer from the Internet) of Kalusugan Pangkalahatan. people die earlier is because they With the current initiatives of have less access to health services and their Margaret Chan stressed, non-communicable government, the DOH is now improving health literacy or the knowledge about diseases (NCDs) are “the diseases that break access of the poor to quality health health-related issues are very limited. the bank”. This is a reality that is experienced care, providing them with financial risk The poor also tends to lead less healthy not only at the personal level but also protection through the expanded coverage lifestyles like drinking, smoking and eating at the country level. For many low- and and enhanced benefits of PhilHealth, and unhealthy food. The lower the social status middle-income countries, scaling up a core improving the quality of health services also translates to more insecurity, stress and intervention package to prevent and treat particularly in the public sector through anxiety, all of which increase susceptibility NCDs is very difficult. health facilities enhancement. Many to disease. And the level of work, degree In the Philippines, two (2) of the interventions are also directed at making of social isolation and sense of control over 10 leading causes of morbidity and seven the society and environment conducive to life could very much affect the likelihood of (7) of the leading causes of mortality in the healthy lifestyle. After all, healthy lifestyle is developing and dying from chronic diseases country today are NCDs or chronic diseases. about getting the right proportions. such as diabetes and cardiovascular disease. The major causes affecting the lives of Health Secretary Enrique T. Ona And sadly, as WHO Director General the people are linked by the common and said, “I don’t think we have been remiss in
March - April 2012 I HEALTHbeat 17 advocating for a health lifestyle. We have healthy lifestyle. Communicable Diseases (PCPCNCD or time and again urged everyone to stop Thus, the DOH holds the commonly known as the NCD Coalition). smoking, to engage in regular exercise, and Outstanding Healthy Lifestyle Advocacy It is a group of 40 organizations working to eat a healthy and well-balanced diet. Awards (OHLAA) every two years to on NCD prevention and control formed on We have had several activities to remind recognize the work of local governments, April 14, 2004 by virtue of a Memorandum everyone about this. Nagiging makulit na other government agencies, and non- of Understanding with the DOH. Among kami pero hinding hindi kami magsasawa sa government organizations, professional its objectives are to: promote policy and pag-papaalala at pangungulit sa publiko ang societies, the private sector, and business legislative environment supportive to the pagpo-promote ng healthy lifestyle.” He, and commercial establishments that have practice of healthy lifestyle; enhance people’s however, stressed that “advocating healthy demonstrated exemplary efforts in the awareness and practice of healthy lifestyle; lifestyles does not only mean badgering and formulation of policies and programs that and enhance surveillance mechanisms for organizing public relations activities, it also promote healthy lifestyle and caused its NCDs. The current chair of the NCD Coalition entails putting in place policies that will be effective implementation. The scope of the is the Philippine Association of Diabetes conducive for the pursuit of healthy lifestyles Awards includes: 1) promotion of physical Educators. among our countrymen.” activity; 2) promotion of healthy diet and On February 29 at the Landbank The DOH wants to cascade its nutrition; 3) tobacco control; and 4) control Plaza, the second OHLAA was held. Out of efforts on the promotion of healthy lifestyle of harmful use of alcohol. the 28 nominees that were screened based to all sectors of society. It is through concrete The DOH staunch partner in on the documents they submitted, eight (8) policies, programs and partnerships that the this endeavor is the Philippine Coalition finalists were shortlisted for the next round country and its people can better achieve for the Prevention and Control of Non- which consisted of site visit and observation,
PRACTICE WHAT YOU PREACH. At the start of the 2nd Outstanding Healthy Lifestyle Advocacy Awards Night, Health Secretary Enrique T. Ona (center) and some members of his Executive Committee join the performers and lead the crowd to an aerobic exercise routine. In the photo are Undersecretary David Lozada, Assistant Secretary and National Nutrition Council Executive Director Maria-Bernardita Flores (extreme left and second from left), Undersecretary Teodoro Herbosa and then Assistant Secretary and now Undersecretary Nemesio T. Gako (second from right and extreme right). (Photo by Paking Repelente)
18 HEALTHbeat I March - April 2012 Municipality of Carmona, Cavite. This is its second OHLAA. Its program known as DAHLIA or Direct Access to Healthy Lifestyle Intervention and Advocacy includes healthy lifestyle exercises, regular medical check-up, lectures on lifestyle-related diseases, creation of social awareness through health promotion messages and materials, supportive facilities like wellness centers, and integration of the program to all sectors of the community. Community-based organizations and workplaces have adopted the DAHLIA program. The program has also been included in the annual investment plan of the municipality, thus, assured of its Carmona Mayor Roy Loyola leads the Balik-Padyak program. Today, more residents ar using bicycle as sustainability in terms of financial support. A a means of transportation and exercise regimen especially in the early morning and late afternoon. system of monitoring, the DAHLIA card, was developed to ensure regular participation and utilize the same as a tool for evaluation and analysis. The commitment of local officials is expressed through policies and laws to include executive orders, memoranda, resolutions and ordinances. Likewise, continuous capability building programs are being implemented to enhance the effectiveness of health workers as implementers. As of now, there are more than 3,000 active participants of DAHLIA who benefit from the program and accept the responsibility of taking care of their health. Municipality of Varuela, Agusan del Sur. The municipality deeply As a DOH Red Orchid awardee for smokefree municipality in 2011, Veruela is serious in implementing its anti-smoking campaign. felt the effect of NCDs. Smoking, alcohol drinking, poor eating habits and the lack interview of key players, and interview of Center in Surigao City; and Heaven on Earth of concern for physical fitness were evident beneficiaries. The finalists were further Vegetarian Wellness Center in Baguio City. in the rising incidence of hypertension and trimmed down to the five (5) winners who chronic obstructive pulmonary diseases received a cash prize of Php 100,000 and And The Winners Are... (COPD) as the top causes of morbidity, a plaque of recognition each. Meanwhile, while stroke, cardiovascular diseases, COPD, the three (3) remaining finalists received Local Government Unit Category cancer and liver cirrhosis as the top causes of a cash prize of Php 25,000 and a plaque of mortality. The rural health unit was tasked recognition each. Two municipalities tied in this to do healthy lifestyle advocacy down to the The finalists are: Municipality of category with only 0.12 percentage points community level, but the burden of doing San Jacinto in Masbate; Taft District Health difference. and not being heard by the majority of the
March - April 2012 I HEALTHbeat 19 Making importance of its numerous recognitions, no less than Davao City Mayor Inday Sara Duterte (fourth from left) is present to receive the OHLAA Government Office Category. constituents was discouraging. This situation that span at least five years in combined Management Program, popularly known as was elevated to the local officials during a implementation. The program includes the the Cardiovascular Disease (CVD) Program, local health board meeting and they decided multi-awarded anti-smoking program. It which started in 2007. The CVD Program to issue an ordinance in March 2011 for an would later become the standard emulated provides concrete interventions using intensive and comprehensive program. by other LGUs in the country. The program population-wide strategies for physical Although self-change to break a bad habit also integrated the nutrition programs activity, tobacco cessation, diet and nutrition, is difficult and would take a very long time that include food fortification, Gulayan sa promotion of stress-free environment, and to do, with the ordinance in effect somehow Barangay and community-based feeding NCD risk factors education. forced people to abide with the law in order programs, among others. Mental Health to avoid penalties. A multi-sectoral task program is being implemented down to Non-Government force was also organized and a battlecry was the barangay level with strengthened Organization Category coined to bring home the message – “Mag linkage with the Philippine Mental Health HL Tayo, Tayo’y Aasenso Kapag May Sipag, Association to further advance its technical Episcopal Diocese of Northern Tiyaga at Malasakit (STM).” The proponents capacity. Davao City has also established Philippines – Bontoc, Mountain of this advocacy program are Mayor Salimar centers and institutions for mental health, Province. True to its mission of nurturing T. Mondejar and Municipal Health Officer, Dr. for women and children in crisis, and congregations as good stewards of creation, Lumira M. Lagapa. rehabilitation centers for drug dependents the diocese implements its comprehensive and people suffering from alcohol abuse. healthy lifestyle program: 1) Healthy Government Office Category Physical activity is also included in the Lifestyle Advocacy through Health Sunday Program where government agencies, celebration and other occasions; 2) No Davao City Health Office. The private institutions and malls are initiating Smoking Campaign; 3) Liquor Ban; 4) city’s healthy lifestyle program is a unique activities to promote healthy lifestyle Junking Junk Foods; 5) Health Assistance mix of a wide range of initiatives for the among individuals in the city. Central to Plan; 6) Organic Food Production (herbal prevention and control of NCD risk factors these initiatives is the Integrated NCD and vegetable gardening in mission schools;
20 HEALTHbeat I March - April 2012 demo organic farming in church lands), and are healthier. Going beyond the confines healthy families and communities of God and; 7) Environment Protection. These were of the church premises, the concerned continue to be built far and wide. initiated by the Episcopal Churchwomen women brought these activities to their because they are greatly bothered by their homes and barangay halls and municipal Commercial/Business drunken smoking husbands. Before the councils resulting in behavior change and Establishment Category smoking ban, men went out of the church the passage of ordinances/policies on junk during sermons to smoke and missed the food ban, liquor and smoking control. With Novartis HealthCare Philip- message. Now they stay put in their seats more cooperation now, the caring and pines. Healthy lifestyle is being promoted internally and externally through the company’s Be Healthy and Kaagapay programs. The Novartis “Be Healthy” program is a group-wide initiative that helps employees adopt and stick to a healthy lifestyle. The program provides employees with information and activities that promote health and prevent illness. It is anchored on four pillars of healthy living: (1) Regular exercise; (2) Healthy diet; (3) Accurate, up-to-date health information; and (4) Maintaining health at work. Moreover, in collaboration with the Department of Health, medical societies and the media, Novartis has been supporting the country’s observance of World Hypertension Day (WHD) since 2008. Through the annual The advocacy of Episcopal Diocese of Northern Philippines resulted in the All Saints’ Mission Elementary WHD celebrations, Novartis and its partners School canteen to serve fresh fruit juice extracts and no “junk foods.” implement innovative, easy-to-do and fun healthy lifestyle initiatives to increase awareness on hypertension, particularly in preventing, diagnosing early, and controlling this “silent killer.” The Be Healthy program generated 100% participation from Novartis employees while over 800 doctors and laypersons participated in WHD-related activities from 2008 to 2011. The OHLAA Board of Judges is composed of DOH Undersecretary David J. Lozada, Jr; Dr. Danilo Baldemor – president of the Philippine Association of Diabetes Educators; Aniceto Sobrepena – president of the Metrobank Foundation; Mariano Gabito - assistant director of the Department of the Interior and Local Government; and Dr. Novartis Philippines has been supporting the country’s observance of World Hypertension Day since Cherian Varghese - NCD technical officer of 2008. the WHO Western Pacific Regional Office.
March - April 2012 I HEALTHbeat 21 tobacco CONTROL The Philippines gets one of five Bloomberg Awards for Global Tobacco Control
HealthJustice Philippines Wins achievement in implementation of MPOWER that will reduce tobacco consumption in policies. The MPOWER strategy, established the Philippines. It was formed in 2008 by Michael R. Bloomberg, philan- by the World Health Organization (WHO), doctors, lawyers, and economists, provides thropist and Mayor of New York City, are the six most effective – and proven – government agencies and advocates with conferred one of the five Bloomberg tobacco control interventions: Monitoring legal information and advice on how to Awards for Tobacco Control to HealthJustice the epidemic and prevention policies, counter these attempts. Philippines for providing tobacco industry Protecting people from secondhand smoke, The CSC-DOH JMC aims to promote monitoring information to government that Offering help to people who want to quit, transparency and accountability, which are led to the issuance and implemention of the Warning about the dangers of tobacco, basic governance values and in line with Civil Service Commission and Department Enforcing bans on advertising, promotion the core value to promote integrity in public of Health Joint Memorandum Circular (CSC- and sponsorship and Raising tobacco taxes service. The tobacco industry has consistently DOH JMC) in order to protect the bureaucracy and prices. The awards ceremony took place used political and economic power to from tobacco industry interference – a first on March 22 in Singapore at the 15th World prevent effective regulation and undermine of its kind in the world. Conference on Tobacco or Health. tobacco control measures. Through the joint The Bloomberg Awards recognize Bloomberg honored the fairly memorandum, the government is able to governments or non-governmental organi- young non-government organization for further control the meddling of the tobacco zations in low- and middle-income countries monitoring the tobacco industry's attempts industry in the way it acts or decides, as well that demonstrate excellent progress or to undermine laws and government policies as show that the government is sincere in its efforts to be transparent and accountable in all its dealings. The CSC-DOH JMC covers all government officials and employees under the jurisdiction of the CSC. It prohibits unnecessary interaction with the tobacco industry. If the interaction is necessary for its effective regulation, transparency must be observed and the interaction should be carried out in such a way to avoid the creation of any perception of real or potential partnership or cooperation. The joint memorandum also prohibits preferential Dr. Daniel Tan, president of HealthJustice Philippines, receives one of five Bloomberg Awards for Global treatment to the tobacco industry and it Tobacco Control from New York City Mayor Michael Bloomberg. Photo grabbed from
22 HEALTHbeat I March - April 2012 sponsorship from the tobacco industry. CSC-DOH JMC. It must be noted that many of currently the largest pack warnings in Dr. Daniel Tan, who received the the tobacco industry's so-called "corporate the world (80% of pack on both front and award on behalf of HealthJustice, said, social responsibility" activities are directed back); “Enforcing” Category - Corporate "We have seen this policy systematically in schools, like building classrooms or stage, Accountability International Colombia denormalize the tobacco industry and painting buildings and holding youth events. (CAI) and Fundaciónpara la Educación y redefine as 'interference' any tobacco HealthJustice also advises other el Desarrollo Social (FES) for their joint industry actions and reactions to various government agencies in the cases filed by effort to strengthen implementation and tobacco control measures, including legal tobacco companies in different courts to enforcement of Colombia’s newly passed challenges in court and personal attacks on skirt the advertising ban, prevent graphic tobacco advertising and sponsorship ban; advocates." health warnings on packs, and relax on and “Raising tobacco taxes” Category – Tan said that the tobacco industry no-smoking spots. It also regularly sends Egypt’s Ministry of Finance for including interference is the single biggest threat advisories to media organizations when a 100% tax on shisha (a tobacco smoked to tobacco control and WHO Framework tobacco companies are trying to get around in a water pipe) and cigarette taxes which Convention on Tobacco Control (FCTC) the rules, or when government officials now represent over 70% of the pack price implementation. This first international and agencies may be getting cozy with the for the most popular brand in Egypt and health treaty – which the Philippines industry, such as when then Senator Richard have generated over 2.2 billion USD in signed along with 173 countries – requires Gordon, as chair of the Red Cross, was government revenue annually. signatory countries to pass laws that will photographed accepting a donation from As no country is currently reduce, and eventually eliminate, tobacco Philip Morris (PM), and when the Bureau of performing at a level of excellence in the use. These laws include those banning Internal Revenue publicized PM as one of the “Offering help to smokers to quit” category, smoking, banning advertisements and top corporate taxpayers. there was no award given in this area. promotions of tobacco products, requiring Former Health Undersecretary and Bloomberg said, “Tobacco kills tobacco companies to put graphic health now PhilHealth's Chief Operating Officer every day but we are fighting back. Our warnings on their products, and preventing Alexander Padilla said, "HealthJustice keeps awardees represent the thousands of government collaboration with the tobacco government people from sliding back, heroes who are taking on the fight against industry. makes people honest. If some sectors think tobacco in their countries, regions and cities "That's why we helped develop HealthJustice is stretching things too far, the every day. We are honoring those who have a government-wide policy that will shield group will always get back to you with the shown exemplary progress since our efforts agencies in the Philippines from tobacco WHO FCTC." commenced in 2007, and we hope their industry influence or threats," Tan added. work will inspire others to achieve similar HealthJustice has also helped Other Awardees success.” the Metropolitan Manila Development Bloomberg Philanthropies works Authority, Land Transportation Regulatory HealthJustice Philippines won primarily to advance five areas globally: Board and a number of local government in the Monitoring category. The other arts, education, environment, government units across the Philippines in their awardees were: “Protecting” Category – innovation and public health. The Bloomberg various tobacco control efforts. Its latest Turkish National Coalition on Tobacco or Initiative to Reduce Tobacco Use is focused feat is in assisting the Department of Health (Turkish acronym: SSUK) for ensuring on reducing the public health impact of Education (DepEd) in issuing DepEd Order that the Turkish national tobacco control tobacco use globally by implementing No. 6 series of 2012 on the adoption and law passed was strong and comprehensive; proven tobacco control policies in low- and implementation of public health policies “Warning” Category – Uruguay Ministry middle-income countries where 80% of on tobacco control and protection against of Health for being a world leader in tobacco-related deaths occur. tobacco industry interference based on the implementing pack warnings, which is - o O o - Catch HEALTHbeat Online:
March - April 2012 I HEALTHbeat 23 stress RELIEF Rated SPG Striktong Patnubay at Gabay Chocolate Sundae Hagis ng Magulang ang Kailangan Sa Fastfood Chain... TITSER: Ang unang makasagot ng tanong JASPER: Kuya, lahat nalang ng palabas ABBY: Isang chocolate sundae nga. ko ay makakauwi agad. ay kailangan ng PATNUBAY at CREW: Ma'am 25 pesos po. PAULO: (Hinagis ang bag sa labas ng GABAY ng MAGULANG... ABBY: (Nagbigay ng 100 pesos) bintana.) DENNIS: Oo nga eh... CREW: Ma'am, meron po ba kayong 5 TITSER: Kaninong bag 'yun? JASPER: May matapos pa kayang gawain pesos? PAULO: Sa'kin po Ma'am! Bye classmates! si Nanay? ABBY: Para kang ex-bf ko, binigay ko na nga ang lahat ng meron ako... Bagsak Ulan tapos, nagkulang pa din ako? CREW: Ma'am hindi ko naman po NELSON: Bakit bagsak grades mo? LITA: Anak, tingnan mo nga kung sinabing nagkulang ka, minsan JERRY: How can I pass if my teacher hates umuulan sa labas? humihingi lang kami ng konting me? Parang love lang yan, kahit JEFF: 'Nay naman. Sa tanda n'yong 'yan halaga para masuklian ka namin gaano ka man kaseryoso, kung kailan ba umulan sa loob? ng buo. ayaw sayo, hindi ka papasa. NELSON: Naks! At nagdrama pa ang bobo. Ito ang Tama Hot Cake REMY: Hoy! Umuwi ka na nga! Inom ka na naman ng inom d'yan! DENPOT: 'Nay penge pera, bibili ako ng JOEREM: 'Nay naman. Nakakahiya sa tropa! High Cake... Wala pa kaming tama. Konti BETH: Engot ka talaga! Kanino ka ba nalang 'to! nagmana? Hot Cake 'yun! REMY: Aan'hin mo pa ang alak, kung sa DENPOT: Ganun ba, 'Nay? Oh, penge na akin palang ay tatamaan ka na! ng pera... Uweeeeh! BETH: Sige, kunin mo dun sa kwarto yung Soldier Bag ko! Walang Mangyayari Switzerland LUZ: Tigilan mo nga yang pagbo- boyfriend na yan... walang NICOLO: Ma, saan nga yung Switzerland? mangyayari sa inyo! ALEGRIA: Ayan kasi. Kung saan-saan lang HANNAH: 'Nay naman... Ba't po kagabi inilalagay ang mga gamit! Tapos meron?!? kapag nawala, sa akin hahanapin!
24 HEALTHbeat I March - April 2012 HEALTH research Tobacco-Free Metro Manila Film Festival Weeeeh... Hindi Nga?!? by ANTHONY R. RODA, MaHeSoS* National Center for Health Promotion Metro Manila Film Festival starts off with a parade of stars aboard extravagant floats on December 24, 2011, In a decade that was regarded to the opening day on Christmas, to the as the second golden age of Philippine glittering awards night two days later, cinema after the 1950s’, the Metro Manila and onto the last day on January 7, 2012. Film Festival began in 1974. It showcased During this period, no foreign movies are quality films besting each other out for shown in all cinemas. acting and technical awards as well as box Most producers gamble their office success. The Festival was organized multi-million peso budgets in the hopes mainly to help promote and enhance the of drawing moviegoers eager to splurge preservation, growth and development of some of their holiday cash. The MMFF has the local film industry. also become one of the more prestigious According to Dr. Romulo A. award-giving institutions in the country, Virola, secretary-general of the National offering huge cash prizes to the winners. Statistical Coordination Board, posted in The Best Picture receives P800,000, while “Statistically Speaking” on February 13, the Second Best Picture and Third Best 2012 at
March - April 2012 I HEALTHbeat 25 Call for Tobacco-Free Movies commented that Tolentino’s appeal or place. A scene is composed of several shots. directive is an encroachment on artistic A shot is a photographic view or exposure The 37th Annual MMFF is freedom. In general, they say that filmmaking and in the study tried to differentiate the spearheaded by the Metropolitan Manila is built on the nuances of characterization smoking exposure into: long shot (full view Development Authority (MMDA) – the and if smoking will project the nature of of object or human figure some relation to overseer of Metro Manila, the Philippines’ a role or enhance cinematography, it is its surroundings); medium shot (a shot of premiere region, which hosts 14 million justified. If the actor’s character is smoking, the person from the knees up or the waist residents and consists of 16 cities and a it does not mean he is setting a bad example up); and close-up (a shot of a person from municipality. MMDA is led by Chairman to the youth. Even in animé, there are the shoulders up). This was done to analyze Francis N. Tolentino, whose current characters who are smoking. Children watch how the film showed detail, character, and “Enforcement of Smoke Free Policy” program this and they know how to distinguish reel intricate emotion to the act of smoking. The regulated the use and consumption of and real life. more medium and close-up shots used, the tobacco products in confined public places. more importance is given to the message of In retaliation to his exemplary advocacy, the Counting Smoking in MMFF Movies smoking. tobacco industry challenged the authority of Although there are several his office, criticized him harshly in the media, The result of Tolentino’s appeal studies of this kind in other countries, this and filed administrative suits against him. for tobacco-free movies seemed to be is a pioneering study in the Philippines, a Tolentino did not waver in his cause and he tried, ridiculed and rejected by more than tobacco-growing country that has banned continued his advocacy even in the holding half of the producers participating in the tobacco advertising in mass media but still of the MMFF. 37th MMFF. A Department of Health study has strong tobacco industry influence in On June 2, 2011 when Tolentino entitled “Tobacco-Free Movies: Is It Possible politics, governance, culture and the arts. announced the extension of the submission in the Metro Manila Film Festival?” counted The results provide a brief snapshot to help of scripts in order to qualify as MMFF entries, the scenes, shots and seconds smoking that understand how smoking is portrayed in he also called on participating movie were shown in each of the seven (7) official Philippine movies. producers to exclude scenes that show actors MMFF entries, analyzed the context in smoking cigarettes. He said such scenes in which smoking was used, and determined if Smoking-Filled Movie Leads films entice people to crave for a cigarette tobacco brands were identified in the movie. and that young viewers alike are enticed to The latter would constitute a violation under Seven entries were included in the smoke as they are indirectly being told that Republic Act 9211 (Tobacco Regulation Act roster of films to the 37th MMFF. Originally, smoking is cool when they see a popular of 2003) that prohibits tobacco advertising 11 films submitted the required scripts to actor puffing a cigarette. He said, “We don’t in mass media. the Festival. Only eight films were chosen want to send the wrong message to our The monitoring of movies was as official entries. However, due to some children. We want to inculcate positive, done in cinemas during the Film Festival production issues, two films pulled out of health-conscious values and awareness.” period. At first viewing, the total number of the competition. One spot was filled in by The Philippines Global Youth running time, scenes and smoking scenes the ninth movie that was earlier not included Tobacco Survey (2007), a school-based were counted. When smoking scenes were in the official list. survey of students 13-15 years old, showed present in a film, a second or third viewing This movie is the “Manila that 27.4 per cent of youth (34.7% males, was necessary to count the total number Kingpin: The Untold Story of Asiong 19.6% females) currently smoke cigarettes. of shots and seconds. The actual counting Salonga,” a black-and-white, biography, And despite the ban on tobacco advertising of scenes, shots and seconds was done gangster, action flick starring Jorge Estregan in Philippine mass media, as high as 88% manually and this becomes the limitation of (a.k.a. ER Ejercito) and produced by VIVA saw pro-cigarette ads on billboards and the study. Accuracy was estimated at plus or Communications Inc. and Scenema Concept 84.7% saw pro-cigarette ads in newspapers minus 10 scenes, shots and seconds. International. It was originally directed by and magazines. A scene is one of the basic structural Tikoy Aguiluz, but he secured a court order Movie folk expressed alarm and units of the film taken at one basic time and to have his name removed from the credits
26 HEALTHbeat I March - April 2012 Counting the Smoking Scenes, Shots and Seconds in the 37th METRO MANILA FILM FESTIVAL Entries
FILM ENTRY/ RUNNING TIME NUMBER NUMBER OF NUMBER OF TIME OF SMOKING GENRE/RATING (minus Closing Credits) OF SCENES SMOKING SCENES SMOKING SHOTS EXPOSURE
Manila Kingpin: 112 mins 00 sec 91 44 181 11 mins 57 secs The Untold Story 62 close-up shots 163 secs 60 medium shots 242 secs of Asiong Salonga 59 long shots 302 secs Action/Gangster/Drama R-13 Shake Rattle 142 mins 03 secs 102 1 2 0 min 14 secs and Roll 13 1 long shot 13 secs Horror 1 close-up shot 1 sec PG-13
Segunda Mano 100 mins 00 sec 84 1 2 0 min 8 secs Horror/Suspense 1 long shot 4 secs PG-13 1 medium shot 4 sec
Yesterday, Today, 113 mins 20 secs 115 0* 0 0 Tomorrow *but in one scene smoking was Drama incorporated in the PG-13 dialogue of one of the main female characters
Ang Panday 2 105 mins 09 secs 79 0 0 0 Action/Fantasy GP
Enteng ng Ina Mo 101 mins 24 secs 77 0 0 0 Comedy/Fantasy GP
My Househusband 106 mins 16 secs 90 0 0 0 (Ikaw Na!) Comedy/Romance PG-13
Note that the actual counting was done manually inside the movie theater, and accuracy is pegged at + or - 10 scenes, shots and seconds.
March - April 2012 I HEALTHbeat 27 of the film due to re-shooting and editing of Forty-four (44) out of the total glamorous woman vacationing from abroad the film without his permission. Darryl dela 91 (48.4%) scenes depicted smoking on and whose role flirts with the lead actor Cruz was eventually named as director. screen, with a computed running time of is shown smoking in one scene and two The movie earned a “Grade A” 717 seconds (11 minutes, 57 seconds). shots lasting for 8 seconds (a long shot for 4 from the Cinema Evaluation Board because There were a total of 181 shots that showed seconds and a medium shot for 4 seconds). it was said to be a “fine example of a period smoking and this is divided into: 62 close- “Yesterday, Today, Tomorrow” film” and because its director was “able to up shots (163 seconds); 60 medium shots is a drama movie billed with a powerhouse establish believable characters through (242 seconds), and 59 long shots (302) cast and riveting performances led by masterfully conceived and executed action seconds. The whole movie, minus the closing Maricel Soriano (MMFF Best Actress) scenes.” The Board is mandated under the production credits, runs 112 minutes (1 hour, and produced by Monteverde’s Regal law to review and grade the quality of films 52 minutes). Entertainment Inc. and Studio 5. Although before being released for public viewing. It there was no smoking scene in this movie, also awards tax incentives to films graded Other MMFF Entries smoking was implied in a dialogue by one “A” and “B” as a way of encouraging Filipino of the main female casts, Carla Abellana. In filmmakers to produce more quality films The other MMFF entries that the middle of a supposed stressful meeting and increase the international marketability showed smoking scenes are “Shake, Rattle in the boardroom, she ended the meeting by of Philippine cinema. This Board is totally and Roll 13” and “Segunda Mano.” saying to her colleagues, “Why don’t we take independent and not at all connected to the “Shake, Rattle and Roll 13” is a break, I’m sure yosing-yosi na kayo (you’re MMFF. the 13th instalment of the Filipino horror raring to smoke).” "Manila Kingpin" also dominated film dating back to 1984. This is a trilogy If this was a deliberate inclusion in the 37th MMFF Awards Night by winning (three episodes) film produced by Regal the script to defy Tolentino’s call for tobacco- a total of 11 awards, including Best Entertainment Inc. and Regal Multimedia free movies, only the producers would Picture, Best Director, Best Screenplay, Best Inc. under the matriarch of Filipino films, know. Incidentally, the MMFF executive Supporting Actor, almost all of the technical “Mother” Lily Monteverde. Incidentally, committee unanimously disqualified the awards, and the special award – Gatpuno Monteverde has been very vocal against film from competing in the Best Picture, Antonio Villegas Cultural Award. MMDA Chiairman Tolentino's call to make the Director, Screenplay and Gatpuno Antonio Ironically, this adjudged quality film entries tobacco-free. She was quoted in Villegas Cultural Award because the movie and best film is filled with tobacco and media as saying, “Hindi pupwede (It cannot was different from the script that was smoking scenes from the first four minutes be). Actors have to bring life to any role and if presented to the committee from which it of the movie up to the last few minutes their character is smoking, it does not mean based its approval and this was considered towards the end. Smoking is also very that they are setting a bad example to the as a violation of the rules. Tolentino said obvious in the movie’s trailer, music video, youth.” that after the script was approved, what was print advertisement and poster. However, in In the first episode entitled shown was different and even the cast was the posters displayed inside the malls where “Tamawo,” an Ilonggo word for a mysterious different. Only the title was the same. the movie was being shown, the cigarettes creature, the rich provincial ranch owner Fortunately, the three family were omitted. is shown smoking in one scene and two entertainment MMFF entries did not show The lead actor and his cohorts shots lasting for 14 seconds (a long shot for smoking scenes. smoked cigarettes, while the main villain 13 seconds and a brief close-up shot for 1 “Enteng ng Ina Mo” was the smoked cigar. The jail warden and some second). The film was judged MMFF third runaway box-office champion, grossing policemen were portrayed as smokers. And best picture. over P183 million in eight days of showing in one sex scene, the lead actor and his “Segunda Mano” is a horror/ in the MMFF. This action, fantasy, adventure mistress use smoking as foreplay. Although suspense movie produced by Star Cinema comedy movie also won the second best there were no noticeable brands of cigarettes and starring Kris Aquino, the Presidential picture. It is produced by Star Cinema and and cigars, the movie seems like one big and sister, and matinee idol and MMFF Best M-Zet Films and the concept came from a long tobacco advertisement. Actor, Dingdong Dantes. In one scene, a fusion of blockbuster hit movies "Enteng
28 HEALTHbeat I March - April 2012 Smoking starts in the first four minutes of the black-and-white film, "Manila Kingpin: The Untold Story of Asiong Salonga," starring Laguna Governor ER Ejercito (a.k.a. Jorge Estregan, forefront). Photo from the Internet.
Kabisote" of Vic Sotto and "Ang Tanging Ina provide an opportunity to convert a deadly to represent the smoking of real historical Mo" of Ai Ai delas Alas. product into a status symbol or token of figures in which the film is based, smoking “Ang Panday 2” is an action, independence. According to the World is overused and over emphasized in this film. fantasy and adventure movie that is also the Health Organization in the second edition And while many movies use sequel to the 2009 reincarnation of one of of “Smoke-free Movies: From Evidence to smoking as a form of relaxation after sex, Fernando Poe, Jr.'s most beloved cinematic Action,” published in September 2011, this movie showed a reversal of imagery. In alter-egos based on Carlo J. Caparas' comics “because smoking on screen is uniquely an interesting and innovative way, smoking creations. It stars Senator Bong Revilla and vivid and because young people see so became a prelude to sex. The lead actor’s produced by Imus Productions and GMA many films so often, its promotional effect mistress, who is also a sex worker, seduces Films. on smoking initiation is striking.” him by lighting two cigarettes and giving “My House Husband Ikaw Na” In “Manila Kingpin: The Untold one for him to smoke. The sexiness of the is a comedy, romance movie produced by Story of Asiong Salonga,” cigarette acting as well as the effect of cigarette OctoArts Films starring reel- and real-life smoking is for the main character who is smoke in a black-and-white film completed couple, Ryan Agoncillo and Judy Ann Santos, a notorious gang leader but a caring, ala the imagery that smoking is sex foreplay. their first movie together since tying the Robin Hood, toughie during his time, and In “Shake, Rattle and Roll 13,” knot. The movie essays a reversal of roles cigar chomping is for the villain who gunned smoking is associated with the rich ranch where the husband found himself out of down the main character. The said villain has owner, while in “Segunda Mano,” smoking work and taking care of the house and a scene where he spits cigar remnants in the is associated with a glamorous woman the two kids, while the wife goes to full- face of a poor, helpless man. Research shows vacationing from abroad and who flirts with time work and becomes successful in her that the villain who smokes can be even the lead actor after his wife supposedly left newfound career. more influential on adolescents than the him. hero. Smoking actors are rich, tough and Tobacco Imagery Viewers Get The movie is set in the 1950s when rebellious while smoking actresses are sexy, smoking was all the rage in real and reel attractive and sophisticated. These are the For the tobacco industry, films life. Although smoking may be necessary messages delivered by the three movies that
March - April 2012 I HEALTHbeat 29 show smoking scenes. For decades, these are World Lung Foundation noted that tobacco found that depictions of smoking in movies the images the tobacco industry use in their marketing increases cigarette consumption are more psychologically powerful than marketing in the hope that young people and seduces new smokers into addiction, cigarette advertisements and have a greater will take part in the exciting lifestyles of the negating public health efforts to control impact on children’s attitudes and behaviors rich and the glamorous, that they will adopt tobacco. The World Health Organization regarding smoking. The research looked at the behaviors they see in these characters Framework Convention on Tobacco Control 51 studies and found that media exposure depicted in the movies. (WHO FCTC), the first global public health to tobacco use increases the odds of youth In “Yesterday, Today, treaty, recommends that “Parties (or taking up smoking almost threefold. Tomorrow,” the message the lady boss countries) recognize that a comprehensive Alas, even with several blurts out to her colleagues in a tiring office ban on advertising, promotion and scientifically-proven evidences all over the meeting that it is time to smoke showed sponsorship would reduce the consumption world, many in the Philippine entertainment smoking is a way to relax and relieve those of tobacco products.” industry do not realize nor believe the impact pent-up stress. But the idea that smoking In the Philippines, the Tobacco that smoking in media has on influencing relieves stress is a myth; rather than help Regulation Act of 2003 (Republic Act 9211) behaviors among children and adolescents. smokers relax, nicotine actually increases prohibits only mass media advertising Even the self-professed non-smoker and anxiety and tension, says Psychologist on television, radio, print and outdoor non-drinker since birth, Cesar Montano, a Andy Parrott, whose findings have been billboards. Advertising and promotions are popular action star who led an anti-smoking published in the medical journal American allowed at points of sale. Limited sponsorship fun run in Manila on November 26, 2011, Psychologist. He explained, “Regular smokers is also allowed. Partial restrictions, like in would not tuck in a smoking scene in any need nicotine to maintain normal moods as the Philippines, are proven to be ineffective of his movies if the scene or the role calls they suffer tension between cigarettes.” in reducing smoking because tobacco for it. He said in one published news report, Meanwhile, in the presentation companies redirect their marketing efforts “I believe that if a scene requires that a of tobacco in the MMFF entries that have to available venues, like the movies. character has to smoke, the act should be smoking scenes or dialogues, there is no In the December 2006 issue allowed. People should be able to draw the message that reflects the dangers and of Archives of Pediatrics and Adolescent line between being oneself and playing a consequences of tobacco use. Medicine, a study “The Extent to Which role.” The Tobacco Atlas (2009) published Tobacco Marketing and Tobacco Use in Films by the American Cancer Society and the Contribute to Children’s Use of Tobacco,” What Can be Done
Internationally, there is no consensus yet on what should be done about smoking on TV and in films. Often, the issues being raised are those of artistic freedom and being truthful/factual (because ordinary people do smoke), especially when dealing with historical films wherein famous people known to have smoked are portrayed or many people of that time/place smoked. Critics of censorship will also ask why alcohol or violence should not be treated in the same way. In Thailand, the act of smoking and any lit cigarette is prohibited on screen, Alas, no movie in the Film Festival depicts true images and messages of the health hazards of smoking, such that any TV shows or movies (including like oral cancer as seen in a patient above. imported movies) that have smoking scenes
30 HEALTHbeat I March - April 2012 are required to block out the hand or mouth film in the voice of the actor shown smoking television programs. This would have been with the cigarette. This is rather ugly and or chewing tobacco. There shall also be a a good measure to prevent producers for quite distracting (but great for raising health warning scroll in legible and readable incorporating smoking scenes. An R-18 or awareness that smoking is bad), so that local font going across the scene as a ticker saying “For Adults Only” rating would not only limit producers have made conscious efforts to smoking causes cancer; smoking kills, viewership of minors, but would also mean not have any smoking scenes in their films/ tobacco causes cancer. As of this writing, limited showing in cinemas because the shows. this notification is being contested by leading chain of malls in the country which In China, the State Administration filmmakers. carry the most number of moviehouses of Radio, Film and Television released an nationwide, ban R-18 movies in their order in February 2011 directing producers Tobacco-Free Movies?!? efforts to make their malls family-friendly. to minimize plot lines and scenes involving However, the MTRCB has still to decide the tobacco and show smoking only when Tobacco-free movies may not be merits of issuing tobacco-free guidelines. necessary for artistic purposes or character possible in the Metro Manila Film Festival Let this be the time to educate development. Minors under age 18 cannot at this time, but the pioneering effort to the filmmakers. Tobacco control advocates be shown smoking or buying cigarettes, and call on filmmakers not to depict smoking should exert efforts in educating filmmakers characters may not smoke in public buildings in their films may be the start of something on the harmful effects of tobacco use and or other places where smoking is banned. big because it has already elicited healthy the evidences that smoking scenes have on In the US, Stan Glantz, professor public discussion and debate. Although the smoking initiation and craving to smoke. of the Department of Medicine and director tobacco industry remains silent on the issue This strategy may encourage them not to of the Center for Tobacco Control Research in media, the move has drawn flak from show smoking scenes or depict the true and Education at the University of California the movie industry but wide support from picture of diseases and deaths brought San Francisco (UCSF) and his group made tobacco control advocates and non-smoking about by smoking in their movies. the following five reasonable, responsible public. This now gives an opportunity not And finally, in a country where steps to protect young audiences from on- only to push for government action but also politics and showbiz are inter-related as screen smoking which were endorsed by the to encourage self-regulation. many politicians crossover to the other US Centers for Disease Control on July 15, MMDA Chairman Tolentino hinted field almost instantly, actor-politicians, like 2011: 1) assigning R ratings to movies that that it is time for the movie industry to Governor ER Ejercito, should be encouraged depict onscreen smoking; 2) requiring anti- run the film festival by itself and without to push forward public health and welfare by tobacco ads in movies that depict smoking; the support of MMDA and the local not being seen in movies as characters who 3) prohibiting on-screen display of tobacco government units. This may be a good idea use and promote a product that is not only a brands; 4) requiring producers to certify that considering that subsidies are provided by health hazard but also deadly. no one associated with a movie depicting the government, even for movies that depict Last February, Congressman tobacco use received compensation for it, smoking scenes. It is about time to consider Aurelio Gonzales Jr. filed a House Resolution and; 5) harmonizing the State movie subsidy such films as indirect tobacco advertising formalizing the appeal that seeks to put an programs with the tobacco control programs and promotion vehicle, which is a violation end to the negative image of congressmen by limiting eligibility for subsidies only to of an existing law, and therefore should not as seen in movies and television shows. He tobacco-free movies. be eligible for any government subsidies or explained that the bad portrayals have been In India, the Ministry of Health tax incentives. unfair to legislators and have only tainted and Family Welfare has issued a notification During Tolentino’s call, the the names of House members who work dated October 27, 2011 that mandates a Department of Health was also reported hard for their constituents. Well maybe, just U/A certification (universal/adult rating) to have consulted Grace Poe Llamanzares, maybe, legislators and other political leaders shall be given for a film in which an actor/ chair of the Movie and Television Review and should also be thinking and working hard actors are shown smoking or using tobacco. Classification Board (MTRCB), regarding the to put a stop in showing tobacco use in all A disclaimer of 20 seconds duration shall be guidelines in the possible implementation forms of media for the sake of all Filipinos! required in the beginning and middle of the of a No Smoking directive in films and Weeeeh... Hindi nga?!?
March - April 2012 I HEALTHbeat 31 laughter HEALS PAG-IBIG
sa Septic WARNING:Tank This page is full of toilet humor. Feelings Putik Tunay na Lalaki
JOJIE: Alam mo para kang inidoro GLADYS: Noon, ang akala ko, ang tao ay DINKY: Ang babae ay parang Barbie. kapag na-jejebs ako. galing sa alikabok at gawa sa Pwede mong paglaruan, at 'pag DANNY: Hahaha. Ang sama. Bakit naman? PUTiK.. naluma na ay pwedeng ipamigay JOJIE: Kasi it’s that feeling... I’m falling JACKIE: Bakit, Mare? Walang pero tandaan mo, ang tunay na for you. katotohanan ba iyon?!? lalaki ay hindi naglalaro ng DANNY: Ako naman when I’m with you GLADYS: Kasi ikaw, gawa sa PLASTIK?!?! Barbie. parang lagi akong naiihi. TERE: Kaya wag n'yo kaming paglaruan JOJIE: Ha? Labi kung tunay kayong lalaki! DANNY: Kinikilig pagkatapos. GANI: Malamig siguro ang labi mo. Tunay na Babae Ayos! EDNA: (Kinilig) Hindi ah, bakit? GANI: Nagyeyelo(w) kasi ang ngipin PHILIP: Ang laki ng problema ko sa syota FLOR: Ayusin mo nga kama mo, hindi mo 'eh. ko, 'Pre. 'yang puro Facebook ang IBARRA: Pare, tandaan mo ito... Ang tunay inaatupag mo. Kadiri na babae ay marunong magluto ERIC: Magugulo lang naman ulit. Bakit tulad ng nanay n'ya. Hindi 'yung ko pa aayusin? Para lang akong Nagkita ang kulangot at tinga... kasing-lakas uminom tulad ng nagmahal tapos masasaktan lang KULANGOT: Oy! Pare kamusta ka na? tatay nya. muli. TINGA: You're here?!? Anong FLOR: Ayun! At nagdrama ang batugan! ginagawa mo dito 'pre? Payabangan 'Wag ka na ring kumain, kasi idudumi mo lang din. Dumi PAKING: Pare yung brief ko hindi T-back ...no back! Hahaha. Imburnal MIKE: Ipapasok ko na, ha? ROMY: Wala 'yan sa brief ko... 'Saken DIANE: Dahan-dahan lang ha? parang lumang plaka. Pwedeng OSCAR: Miss, imburnal ka ba? MIKE: Ako ang bahala. Side A at Side B! Hahaha. DELIA: (Kinikilig) Bakit naman? DIANE: Aaahhh... Ang sarap! ARIEL: Yuck...grabe naman 'yan. Pare OSCAR: Tanga lang kasi ang mahuhulog MIKE: Ididiin ko pa! yung brief ko parang blockbuster sa 'yo! DIANE: Oo sige, ikut-ikutin mo pa! na pelikula... DELIA: Ah, ganun ba? Hmmp! MIKE: Ayan, malinis na. Sa kabilang PAKING: Bakit?!? OSCAR: At isa na ko sa tangang 'yun. tenga naman. ARIEL: NOW ON ITS SECOND WEEK!
32 HEALTHbeat I March - April 2012 HEALTH policy
Health Secretary Enrique T. Ona, during the hearing on excise tax reform on alcohol and tobacco products, explaining that the main intention of House Bill 5727. (Photo by Paking Repelente) Honorable Legislators, Please Pass The Abaya Sin Tax Bill by DONATO DENNIS B. MAGAT and ANTHONY R. RODA, MAHeSoS HEALTHbeat Staff
Congress Delayed is Health Denied still take a while or even the next Congress standards. to do so even if it has been classified urgent The country’s cigarettes and There is a tug-of-war in the House by President Benigno S. Aquino III and with alcoholic drinks are among the cheapest of Representatives in reforming the excise pressures from the World Trade Organization in the world! Cigarettes, for example, tax structure of the so-called “sin” products, for the government to enact a new excise tax have become cheaper relative to basic particularly tobacco and alcohol, and it may law that would be compliant with the global commodities such as food, education, and
March - April 2012 I HEALTHbeat 33 health in the past 10 years. The current country. and more lucrative livelihoods. multi-tiered tax system puts the youth and The government is in a financial This sin tax reform would have the the poor in a trap by the ills of smoking and crisis and it badly needs more revenues. effect of raising an additional P400 billion in drinking as it encourages them to shift from Increasing sin taxes will be the most effective revenues for the government during the last higher-priced to lower-priced brands. and efficient tool to raise a significant four years of Aquino’s term. Increasing the tax and price of amount of revenues in the short to medium Meanwhile, the Department of cigarettes and alcohol will effectively help term. Even with improved tax administration Health projected that an increase in sin protect the young and the poor from the under the Aquino administration, tax effort taxes would generate at least P60.7 billion harmful effects of smoking and drinking. has remained low at 12% of gross domestic in additional government income annually. Addiction to smoking and drinking usually products (GDP). Moreover, GDP growth rate Of this amount, P45 billion will be allocated happens when individuals start these vices was only 3.7% in 2011. While the budget to tobacco farmers while the remaining at a very young age. Studies have also deficit was reduced to P96 billion in 2011, will be used to fund the government’s shown that the health effects of smoking the government was not able to spend for universal health care agenda or Kalusugan and drinking are worst for those who begin essential public services, which is the main Pangkalahatan. smoking and drinking in their youth. Hence, reason for the close-to-stagnant status of the young population needs the most the economy in 2011. Here Comes The Opposition protection from picking up these vices. On the other hand, the poor Why the Abaya Bill The move to raise sin taxes is being smokes and drinks more than the rich. The opposed by lawmakers from the Solid North poor also have the least capacity to get the There are 12 pending measures in – the traditional tobacco-growing regions needed health care when they get sick due Congress seeking to restructure the excise of Ilocos, Cagayan Valley and Central Luzon to smoking- and alcohol-related diseases, tax on alcohol and tobacco products, but – claiming it would kill the tobacco industry and are the most vulnerable to chronic the one being supported by the Aquino and threaten the livelihood of 2.9 million poverty when they experience health shocks administration is House Bill (HB) No. 5727, tobacco farmers and workers and their due to these vices. Moreover, the poorest penned by Cavite Representative Joseph dependents. households spend more on tobacco and Emilio Abaya, the chair of the House Ryan Singson, Ilocos Sur 1st alcohol more than education or health care. committee on appropriations. District Representative, warned that if Hence, the poor also needs to be protected The following are the salient the government proceeds with its plan of from the harm caused by smoking and features of the Abaya bill: adopting a unitary tax system for alcohol drinking. • IT MOVES FROM A MULTI-TIERED and tobacco products, tobacco-producing Local studies and reports show TO A UNITARY TAX SYSTEM: It will simplify farmers of his province would have a difficult that many Filipinos are dying and the the current multi-tiered tax structure. Only time finding buyers for their products. Philippines is in a health crisis. Some 515 to one tax rate for all cigarettes and one tax rate The unitary tax system would make 827 Filipinos contract smoking-related lung for distilled spirits; cigarette brands currently taxed at P5 per cancer and lung and heart diseases DAILY! • IT INDEXES TAXES TO INFLATION: pack pay P40-P45 per pack in three years. About 240 Filipinos die daily because of After reaching the unitary tax system, taxes Meanwhile, local distillers led by the giant smoking-related diseases. Of the 10 leading will be automatically increased yearly, to San Miguel Corporation, also warned that causes of mortality, seven (7) are smoking- follow inflation; and the 1,000-percent hike in taxes being sought related. Although government revenue from • IT DEDICATES TAXES TO by the sin tax measure would drive local tobacco taxes is about P23 billion annually, UNIVERSAL HEALTH CARE AND ALTERNATIVE players out of business and leave hundreds the economic burden of health costs and LIVELIHOOD FOR TOBACCO FARMERS: Part of of thousands of workers jobless as domestic productivity losses of only four smoking- the taxes will be used for the Aquino Health brands would lose their price advantage over related diseases – cancer, heart diseases, Agenda of providing universal health care for foreign brands. stroke and chronic pulmonary diseases – all Filipinos. Another portion will be used to Singson filed a substitute version add up to P148 to P314 billion yearly in the aid tobacco farmers in shifting to alternative of the sin tax bill that supposedly intends to
34 HEALTHbeat I March - April 2012 balance competing interests, but a careful products, he had come to the conclusion on the enactment of the Abaya bill, which scrutiny of the bill shows that it does not that only manufacturers prospered at the he said is an “improved” version of the serve the public interest. expense of the farmers. Department of Finance’s (DOF's) proposal According to the Action for Chavit said that he was alarmed under the Arroyo administration. “I want Economic Reforms, an independent, when two giant tobacco companies merged it to be like the Conditional Cash Transfer. reform-oriented policy group that conducts because they would monopolize the The funding for tobacco farmers was not analysis and advocacy on key economic industry to the detriment of farmers and included on our proposed bill during my issues, the Singson bill does not reform small companies. He vowed to explain the time. But with HB 5727, farmers are assured the existing weak and backward law. It benefits of supporting and passing of the of income in the event that they would shift introduces a new classfication system that Abaya bill to other congressmen and tobacco to other crops,” he said. will merely perpetuate the weaknesses in farmers in his area. The bill provides a safety net for the law. It does not introduce indexation Meanwhile, Umali who leads the tobacco farmers. The history of tobacco to inflation. Its tax rates are very low, and the LPP, the organization of all provincial farming in the Philippines showed that it is cannot even correct the losses from inflation governors in the country, said, “The LPP declining and a lot of farmers have shifted in the previous years. This defeats the twin supports this landmark legislative measure to other crops. In the 1990s, 69,000 hectares objectives of significantly yielding revenues (HB 5727) which will generate revenues to in the country were used for tobacco, but it for government and stemming the rise of finance public-private partnership projects, is now down to 30,000 hectares. In studies both communicable and non-communicable prevent smoking related expenditures, and made by the Department of Agriculture, the diseases arising from tobacco and alcohol save young and poor countrymen from possible alternatives for tobacco would be consumption. lifestyle diseases.” sweet corn, tomatoes, sweet pepper and Former Finance Secretary bitter gourd. Pro-Abaya Bill in Full Force Margarito Teves also expressed the urgency Aside from Teves, 12 former
The League of Provinces of the Philippines (LPP) through its National President, Oriental Mindoro Governor Alfonso “Boy” Umali and its National Chairman, Ilocos Sur Governor Luis “Chavit” Singson recently joined mounting calls for the passage of the Abaya bill. With Chavit in this corner of the arena going against his son’s bill, the sin tax debates becomes more intriguing. “It’s high time that we raise the taxes for tobacco products as this will not only raise funds for the health sector but benefit the tobacco farmers,” proclaimed Chavit whose province is the among the leading producers of tobacco products in the country. “I am calling our honorable legislators to approve the Abaya Bill and pave the way for the realization of the Universal Health Care,” added the IN FULL FORCE PUSHING FOR THE ABAYA BILL. From left to right: Oriental Mindoro Governor Alfonso “Boy” Governor. He said that after years of Umali, Health Secretary Enrique T. Ona, Ilocos Sur Governor Chavit Singson, and BIR Commissioner Kim opposing increased taxes on tobacco Henares. (Photo by Paking Repelente)
March - April 2012 I HEALTHbeat 35 government officials expressed their support secondhand smoke contains not just Singapore. for the Abaya bill through a position paper nicotine and tar but more than 7,000 other The NYC reiterated a recent study signed during a press briefing. They are chemicals, including hundreds that are toxic by the University of the Philippines-Diliman former DOF secretaries Ernest Leung, Roberto and about 70 that can cause cancer. WHO has Communication Research Society that de Ocampo, Jesus Estanislao and Ramon del a very clear stance on tobacco control and is revealed 60 percent of its respondents will Rosario; former DOF undersecretaries Romeo determined to help governments protect the quit smoking if cigarettes were priced at P5 Bernardo and Milwida Guevara; former DOH health of their people. per stick. secretaries Alberto Romualdez, Esperanza "We realize that developing The NYC said that based on its Cabral, Jaime Galvez Tan, Juan Flavier and strong tobacco control policies is not “conservative estimation,” two out five Alfredo Bengzon; and former National simple. Nevertheless, we know that the Filipino teens aged 13 to 15 years smoked Treasurer Leonor Briones. restructuring of tobacco prices and taxes in 2011. This computation was based on For her part, Bureau of Internal in the Philippines would significantly the Philippines Global Youth Tobacco Survey Revenue Commissioner Kim Henares reduce tobacco consumption and prevent which showed that 19.6 per cent of the age emphasized that the Abaya bill is being unnecessary suffering and death from group smoked in 2003. This figure increased pushed for its benefits for the health of cancer, heart disease, stroke, and such to 27.3 per cent in 2007. The NYC estimated Filipinos as it seeks to prevent smokers and chronic respiratory diseases as emphysema, that youth smokers increased by 40 percent potential smokers from indulging in this which, with diabetes, are now the leading last year. addictive and harmful behavior. She said causes of illness and death in the country,” Health Secretary Enrique T. that the bill would tax all tobacco companies The National Youth Commission Ona expressed great satisfaction at this similarly, and added that it is unfair for non- (NYC) is also in the bandwagon appealing development which bodes well for the smokers to pay for the health bills of smokers. to Congress for higher taxes on cigarettes Abaya bill. With the proposed bill, the government to discourage Filipino youth from acquiring “We appreciate the support of through its Kalusugan Pangkalahatan the deadly habit. NYC Commissioner Percival our partners who fully understand how this agenda, it will have enough money to Cendana said, “We have one of the cheapest measure will boost our fight against the shoulder expenses of smoking-related prices of cigarettes, not only in Southeast menace of non-communicable diseases as diseases. Asia but also in the Asian region. At present, well as our efforts to achieve Kalusugan Dr. Shin Young-soo, World Health a local cigarette stick costs P2.” Pangkalahatan, he said. Ona also revealed Organization (WHO) Regional Director for The most popular brands of that the bulk of the projected revenue from the Western Pacific Region, also throws in cigarettes sold in the Philippines cost an the measure will be channeled to finance his support the use of a percentage of the average of less than 50 cents per pack. By of the administration’s effort to achieve proposed tobacco tax increase for health. contrast, in the Lao People's Democratic universal health coverage in PhilHealth and "For a half century, the scientific Republic cigarette prices recently doubled to enhance the nation’s health care system community has generated solid and to about one US dollar per pack. In Malaysia, by upgrading government health facilities to robust evidence to show how smoking and cigarettes cost three US dollars per pack. The provide better health services. exposure to secondhand smoke directly average cost of a pack of cigarettes in Hong “We again urge legislators to pass harms health," Shin said. "We know that Kong (China) is six US dollars and nine in the sin tax reform bill,” Ona concluded.
HEALTH tip Coffee With Dinner? Try Decaf... That after-dinner cup could be interfering with your sleep. To get a good night's rest, avoid caffeine for eight hours before bedtime. While your body doesn't store caffeine, it takes many hours to eliminate the stimulant from your system. (Lifted from Mayo Clinic website.)
36 HEALTHbeat I March - April 2012 Muslim HEALTH Why Nicotine is So Addictive by TATO M. USMAN, MD, MPAIM DOH Center for Health Development - Autonomous Region in Muslim Mindanao
Addiction is defined as compulsive use despite damage to the individual or society and drug-seeking behavior can take precedence over important priorities. It persists despite a desire to quit or even repeated attempts to quit. Nicotine is an alkaloid found in the nightshade family of plants that constitutes approximately 0.6%-3.0% of the dry weight of tobacco, with biosynthesis taking place in the roots and accumulation occurring in the leaves. Nicotine is the tobacco plant's natural protection from being eaten by insects. Its widespread use as a farm crop insecticide is now being blamed for killing honey bees. A super toxin, drop for drop it is more lethal than strychnine or diamondback rattlesnake venom and three times deadlier than arsenic. Nicotine: C10H14N2 . Photo grabbed from the
March - April 2012 I HEALTHbeat 37 hunger and yearning. vulnerable to tobacco addiction. to numb the throat to mask the On one hand, smoking a single Likewise, ammonia added to aggravating effects of tobacco cigarette may provide enough nicotine to commercially made cigarettes can boost smoke; initiate the addictive process, a recent study the availability of nicotine up to 100 times, • Additives such as cocoa are used found. That is because a small quantity of says a new study by the Oregon Graduate to dilate the airways allowing the nicotine, roughly equivalent to what is found Institute of Science and Technology in smoke an easier and deeper passage in one cigarette, can produce long-lasting Portland. The study supports the claim of into the lungs; and changes in the dopaminergic reward centers many critics of the tobacco industry that • Additives are used to mask the of the midbrain. By studying rat brain tissue, ammonia enhances the effect of nicotine, a smell and visibility of smoke that is University of Chicago researchers found that claim that tobacco companies have denied. not breathed in by the smoker. the nicotine in cigarettes not only directly The process of increasing the stimulates nicotinic acetylcholine receptors impact of nicotine by adding ammonia is The Islamic Stance in the ventral tegmental area (VTA), one called "free-basing" to heighten the effects on Tobacco Addiction of the dopaminergic reward centers of the of nicotine. midbrain, but also alters synaptic function in Nicotine exists in two forms, Eminent Muslim scholar Sheikh the VTA. namely: acid and base. When ammonia is Yusuf Al-Qaradawi, states: “There is harmful In the study by Huibert Mansvelder, added, the nicotine converts from acid to effect of smoking that is disregarded by those PhD and Dr. McGehee, the direct stimulatory base form. The base form can vaporize more who have tackled the issue of smoking like effect on the nicotinic acetylcholine receptors easily from the smoke particles into the the negative psychological effect. Getting in the midbrain was short-lived because gas phase, enabling it to deposit directly accustomed to smoking enslaves one's these receptors desensitized in a matter of on the lung tissue and immediately diffuse will and makes it a prisoner of that foolish seconds. However, nicotine also induced a throughout the body. habit that one can hardly give up even if long-term potentiation of excitatory input to Although the research has shown one decides to do so one day for a certain the dopamine neurons. that ammonia makes nicotine more available reason, such as noticing its obvious negative This phenomenon, said Dr. from cigarette smoke, James F. Pankow, one effect on one's health or concerns about McGehee, probably explains the sustained of the authors of the study, warns that more upbringing one's children, or discovering rise in dopamine release that follows research needs to be done to determine one's need to spend one's money on useful nicotine exposure; the root cause appears whether "the increased chemical availability and beneficial matters, or for any other to be activation of presynaptic alpha 7 translates into a more rapid uptake of similar reason. Due to such psychological subunit containing nicotinic acetylcholine nicotine by the smoker." enslavement, most often than not, smoker receptors on glutamatergic terminals. This Similarly, the Action Smoking on neglects to meet the needs of one’s family activation results in an ongoing increase in Health and the Imperial Cancer Research because one is addicted to smoking, from the excitatory input to the VTA. Fund say that they have evidence uncovered which one has become unable to free Recently, the National Institute on by a review of tobacco industry documents oneself. In addition, if a smoker cannot Drug Abuse-funded researchers have shown that: afford it for a single day, due to an internal or in animals that acetaldehyde, another • Additives are used to make external reason, one becomes afflicted with chemical constituent of tobacco smoke, cigarettes that provide high levels a state of disorder, imbalance, irritation and dramatically increases the reinforcing of 'free' nicotine which increases the anger for the slightest reason.” properties of nicotine and may also addictive kick of the product; In gist, there is a clear link among contribute to tobacco addiction14. • Additives are used to enhance the acetaldehyde, additives (like ammonia), The investigators further report taste of tobacco smoke; nicotinic receptors (including alteration of that this effect is age-related, with adolescent • Sweeteners and chocolate are used synaptic function in the VTA) and dopamine animals displaying far more sensitivity to to make cigarettes more palatable to that makes nicotine more addictive. this reinforcing effect 14, suggesting that children; Allah Almighty knows best. the brains of adolescents may be more • Eugenol and menthol are added - o O o -
38 HEALTHbeat I March - April 2012 environmental HEALTH Photo floatsPhoto online.
The AIR POLLUTION that we breathe by ABIGAIL CORPUZ-QUETULIO HEALTHbeat Staff
Breathing can be dangerous in Resources (DENR), around 80% of Metro contamination of indoor or outdoor Metro Manila. Manila’s air pollution comes from vehicles environment by any chemical, physical or A few years back, I was confined at while around 20% comes from factories, biological agent that modifies the natural the Lung Center of the Philippines for a lung waste burning, and dust. characteristics of the atmosphere. According surgery that was caused by a congenital Poor air quality affects health to a World Bank study, around 18 million anomaly. After the operation, I was given a and daily exposure to polluted air can be Filipinos are exposed to air pollution, copy of my medical records and there I saw associated with worsening lung problems resulting in an annual national economic loss the condition of my lungs and how they and increased cardiovascular events such as of P7.6 billion due to human productivity looked like. I noticed there were tiny spots/ stroke and heart attacks. The Department loss. stains in my lungs and when I asked the of Health records show that three of the DENR Secretary Ramon J. P. Paje surgeon about it, he said those stains were top 10 causes of deaths (chronic lower stressed, “We need to reverse this trend, or just caused by the air pollution in Metro respiratory diseases, diseases of the heart, at least put a stop to it not only for the sake Manila. I realized that this happened to my and pneumonia) and four of the top 10 of the economy, but more importantly, to lungs after only five years' stay in Metro causes of illness (acute lower respiratory improve our quality of life.” Manila. I dreaded the thought of the extent tract infection and pneumonia, bronchitis/ of damage the air pollution would bring to bronchiolitis, diseases of the heart, and Air Pollutants and Health my health in the next coming years. acute respiratory infection) are related to air Metro Manila has the worst air pollution. The following are the common air pollution in the country today. According to Air pollution, as defined by pollutants and their health effects: the Department of Environment and Natural the World Health Organization, is the Particulate Matter (PM) or tiny
March - April 2012 I HEALTHbeat 39 airborne particles or aerosols of two sizes: 10 micrometers or less and 2.5 micrometers or less. These are collectively referred to as total suspended particles (TSP), a regulatory measure of the mass concentration of PM in community air. These particles constantly enter the atmosphere from human sources like motor vehicle use, combustion products from space heating, industrial processes, power generation, and smoking tobacco. The health effects include reduced lung function, inflammation of the lungs, increased susceptibility to respiratory infections, aggravation of heart and lung diseases, and may cause chronic bronchitis and lung cancer. Sulfur Dioxide (SO2), a poisonous gas with a pungent, irritating smell released from vehicular emissions, combustion of fossil fuel (coal and heavy oils) and industrial emissions. Its health effects are breathing Man-made outdoor and indoor air pollution affects the lungs and other vital organs of the body. Photo difficulties, eye irritation, chest tightness, grabbed from
Nitrogen Oxide (NO2) is a binary solid form of the compound and enter the Anthracene and Phenanthrene. They compound of oxygen and nitrogen or a surrounding air. VOCs are numerous, varied, are produced by combustion processes, mixture of such compounds found in vehicle and ubiquitous. They include both naturally including solid fuel use in households; exhaust, tobacco smoke and smog. Its occurring chemical compounds and man- tobacco smoke; vehicular and industrial health effects are irritation of the respiratory made like in vehicular emissions and emissions. Long-term exposure to PAH can tract, increased susceptibility to respiratory biomass burning. VOCs can cause irritation lead to cancer, and affects the reproductive infection, and impaired lung function. of the eyes, nose and throat, headaches, system, liver, lungs and skin. Carbon Monoxide (CO) is a nausea and loss of coordination. colorless, odorless, and tasteless gas that is Ground Level Ozone (03) or Usok Mo, Buhay Ko slightly lighter than air. It is found in vehicular “bad” ozone is not emitted directly into the emissions resulting from incomplete atmosphere. It results from photochemical On February 29, the DENR and its combustion. It can cause headaches, reactions between NO2 and VOCs in the partners conducted a Clean Air Summit for dizziness, chest pains among those suffering presence of sunlight. It can cause itchiness Metro Manila dubbed as “Usok Mo, Buhay from cardiovascular disease, and death and burning of the eyes, irritation and Ko” which was participated in by close to when exposed in high concentration. inflammation of the lungs, breathing 400 participants coming from national Volatile Organic Compounds difficulty, and increased susceptibility to government agencies, local government (VOCs) are organic chemicals that have respiratory infections. units (LGUs) and civil society. a high vapor pressure at ordinary, room- Poly-Aromatic Hydrocarbons The Summit was organized by the temperature conditions. Their high vapor (PAH) are chemical compounds that contain DENR’s Environmental Management Bureau pressure results from a low boiling point, more than one fused benzene ring. They (EMB), along with the Department of Interior which causes large numbers of molecules are commonly found in petroleum fuels, and Local Government, the Department of
40 HEALTHbeat I March - April 2012 Transportation and Communication (DOTC), Dr. Mike Aragon, PMA media affairs 2005-2007, the TSPs were on a decreasing the Metro Manila Development Authority chairman, said laws and policies governing trend – from 144 to 97 microgram per (MMDA), the Kapisanan ng mga Brodkaster air pollution need amendments to make Normal cubic meter (ug/Ncm) but the ng Pilipinas (KBP) and the Philippine Medical them attuned to the times. “Enforcement concentrations are still above the annual Association (PMA). Late last year, the DENR, is the problem. Unsustained enforcement mean for TSP guideline value for one year of PMA and KBP signed a Memorandum of of the law coupled with graft is a major 90 ug/Ncm. Agreement that sought to strengthen the stumbling block in eliminating air pollution The DENR has already set up anti-smoke belching program in Metro in the National Capital Region,“ he said. PM10 monitoring stations in Metro Manila.
Manila in an effort to maintain reduced Dr. Mardave Martinez, PMA vice There are nine stations monitoring PM10, particulates in Metro Manila. PMA and KBP president, said air pollution “kills” and it 6 of which are manual and are situated in committed to help raise public awareness should not be tolerated. Before death comes, Caloocan, DOH Manila, MRT Pasay-Taft, on the urgency of addressing the country’s an affected family will first suffer from huge Marikina, National Printing Office (NPO)- worsening air pollution problem. hospital expenses and loss of income due to EDSA and MMDA Guadalupe. There are three The Summit drew attention to the sickness related to air pollutants, he said. automatic stations and these are located at unhealthy effects of constant exposure to Meanwhile, Health Secretary Radyo ng Bayan in Valenzuela City, Ateneo air pollution especially in Metro Manila, and Enrique T. Ona said that having a systematic University and National Mapping and enjoined commitments from various sectors and strict implementation on programs and Resource Information Authority (NAMRIA) to address the problem. It was agreed upon initiatives to reduce air pollution would have which also measures PM2.5. during the summit that there was need for a direct health significance. As the present Based on EMB records, most “no nonsense crackdown plus a readjustment administration seeks towards achieving stations showed readings that exceed the on policies involving the implementation” of Kalusugan Pangkalahatan (Universal PM10 annual guideline value of 60 microgram the Clean Air Act. Health Care), strengthening the promotion per normal cubic meter as provided for in Under the Clean Air Act, the and monitoring for air quality is indeed an the Clean Air Act. These are the stations at DENR has a major role as it serves as the important health issue to address. As every NPO-EDSA (74 ug/Ncm), Marikina (66 ug/ environmental pollution regulatory agency Filipino deserves access to quality health Ncm), Pasay-Taft (130 ug/Ncm), Valenzuela- particularly for air quality by setting care services, everyone also deserves a good Radyo ng Bayan (64 ug/Ncm) and Caloocan- standards, enforcement and monitoring. fresh air to breathe in especially here in Partisol (168 ug/Ncm). The DOH, on the other hand, has the Metro Manila. Paje added that the installation of role of participating in the development additional monitoring stations on PM10 and of air quality policies, guidelines and Measuring Air Quality PM2.5 is now underway. For 2012, the DENR standards. The DOH also provides health will put seven more PM10 and PM2.5 stations, information relative to diseases related to A month after the Summit, the and eventually work towards setting up air pollution. The Department of Energy DENR reported that it has started putting stations in all cities and municipality of sets specifications for all fuel types and air quality monitoring stations capable Metro Manila in 2013. fuel-related products. Meanwhile, the DOTC of gathering PM10 and PM2.5. The TSP will Paje stressed the need for more through the Land Transportation Office still be monitored, but Sec. Paje said, “We intervention to achieve healthy air quality. (LTO) conducts roadside inspection and do recognize the importance of shifting This includes the enhancement of anti- emission tests for approval and renewal of to measuring PM10 PM2.5 as the more smoke belching operations in Metro Manila; vehicle registrations. The LGUs including appropriate indicators of the adverse the adoption of more stringent emission MMDA and as deputized by the LTO also impacts of air pollution on human health.” standards for all types of motor vehicles; conduct roadside inspections and emission He stressed that with the levels of and stricter monitoring of private emission test for smoke belching vehicles. They are TSP going down, the DENR can now focus testing centers and motor vehicle inspection also mandated to implement the banning more in coming up with concrete measures stations with the use of closed-circuit of smoking in public places and burning of to address PM10 and PM2.5 pollution. Based on television or CCTV cameras. wastes. the DENR National Air Quality Status Report - o O o -
March - April 2012 I HEALTHbeat 41 physical ACTIVITY HEALTHY LIFESTYLE Banat ni Lolo, Hirit ni Lola
Old Age Doesn't Mean Poor Health (WHO), said, “When a 100-year-old man first time, there will be more people in the finishes a marathon, as happened last year, world aged over 60 than children aged “Banat ni Lolo, Hirit ni Lola” may we have to rethink conventional definitions less than five. By 2050, 80% of the world’s sound vulgar, but it’s not! of what it means to be ‘old’. Stereotypes older people will be living in low- and It is the way the Department of developed in past centuries no longer hold.” middle-income countries. The main health Health is encouraging the older population Life expectancy is going up in most challenges for older people everywhere are to live a healthy lifestyle and participate countries, meaning more and more people noncommunicable diseases (NCDs), such as fully in society by making important live longer and enter an age when they may heart disease, stroke, cancer, diabetes, and contributions as family members, volunteers need health care. Meanwhile birth rates chronic lung disease. and as active participants in the workforce. are generally falling. Countries and health With the rapid ageing of Old age should no longer be equated with care systems will need to find innovative populations, finding the right model for poor health. and sustainable ways to cope with the long-term care becomes more and more Dr. Margaret Chan, director- demographic shift. urgent. “People in low- and middle-income general of the World Health Organization In the next few years, for the countries currently face up to four times the
42 HEALTHbeat I March - April 2012 risk of death and disability from NCDs than environments that foster the health Moreover, the DOH is currently people in high-income countries, yet most of and participation of older people. lining up appropriate and quality health care these conditions are largely preventable or • "Reinvent ageing" - changing social services for the elderly, especially those who inexpensive to treat,” says Chan. attitudes to build a society in which belong to the marginalized sector. This year, on the occasion of the older people are respected and Last year, 197,000 pneumococcal World Health Day (April 7), the WHO is valued. and 173,000 influenza vaccines were calling for urgent action to ensure that, at a delivered to all Centers for Health time when the world's population is ageing Ageing Population in the Philippines Development (DOH regional offices) and rapidly, people reach old age in the best provided for indigent senior citizens. Health possible health. In the Philippines, the population Secretary Enrique T. Ona also revealed that The risk of developing all NCDs can of 60 years or older was 3.7 million in 1995 the DOH is targeting to give out 1,043,745 of be significantly reduced by adopting healthy or 5.4% of the total population. In the 2000 the said vaccines this year for indigent senior behaviors, such as being physically active, census, according to the National Statistical citizens aged 60 years old and above using eating a healthy diet, avoiding the harmful Coordination Board, this increased to about the National Household Targeting System use of alcohol and not smoking or using 4.8 million or almost 6%. At present, there of the Department of Social Welfare and tobacco products. The earlier people adopt are 7 million senior citizens (6.9% of the Development. these behaviours, the better their chance of total population), 1.3 million of which are The DOH also conducts a "Summer enjoying a healthy old age. Healthy lifestyle indigents. Camp ni Lolo at Lola" every May and from the very beginning of life is key to a With the rise of the ageing supports the Walk for Life" for the elderly healthy and active old age. population is also the increase in the every October. The WHO highlights the need demand for health services by the elderly. for countries to take steps to prevent NCDs According to a study on the share of health Good Health Adds Life to Years and to ensure that systems and services expenditure of Filipino elderly on the are in place to provide treatment and care national health account (Racelis et al, 2003), World Health Day is celebrated when it is required. Many of these services the elderly are "relatively heavy consumers on April 7 to mark the anniversary of the are highly cost-effective. For example, high of personal health care (22%) and relatively founding of the WHO in 1948. The day fell on blood pressure – a key risk factor for both light consumers of public health care (5%)." Black Saturday this year and the DOH and its heart disease and stroke – can be effectively From out-of-pocket costs, the aged are heavy partners moved the celebration to April 11 at treated for just a few dollars a year. Today, users of care provided by medical centers, the Quezon Memorial Circle in Quezon City. less than 15% of older people in low- and hospitals, non-hospital health facilities and The worldwide theme "Good Health Adds middle-income countries in need are traditional care facilities. Life to Years" was transformed into a more receiving treatment for high blood pressure. Fortunately in the Philippines, fun way of doing things in the Philippines The WHO has outlined four key like in most Asian countries, it is customary and became "Healthy Lifestyle: Banat ni Lolo, actions that governments and societies can for the family elder to be cared for by his Hirit ni Lola.” In the event, a dance-exercise take now to strengthen healthy and active children or other relatives. There is a sense video for senior citizens was launched to ageing. of respect and reverence of Filipinos to the provide them with opportunities in adopting • Promote good health and healthy elderly. Adult children care for their parents a healthy lifestyle. The exercise video was behaviours at all ages to prevent or out of respect and gratitude for raising developed by the Strength and Conditioning, delay the development of chronic them. The government is also making sure Inc. in collaboration with the DOH and WHO diseases. that Filipino elderly are assisted in old age. Philippines Office. • Minimize the consequences of An Office for Senior Citizens Affairs in cities The Philippine Physical Activity chronic disease through early and municipalities attends to their needs, Guidelines generally prescribes 30 minutes detection and quality care (primary, while the senior citizens' ward in every to one hour of physical activity and exercise long-term and palliative care). government hospital provides better health per day which can be done in accumulated 10 • Create physical and social care. minute bouts throughout the day or in one
March - April 2012 I HEALTHbeat 43 continuous session. For older population, 12 minutes in length, it may be repeated if can cause potentially dangerous outcomes 60 years old and above, at least 30 minutes more exercise is desired. However, it must such as injury and illness. To reduce the of light to moderate physical activity, be emphasized that physical activity is best risks associated with physical activity and accumulated or in one session, is needed for done with variety to effect balance and exercise, a clearance from a physician is most days of the week, if not daily. moderation. As such, other forms of physical needed and adherence to the limitations Older adults need their balance, activity should be done to complete the 30 prescribed by the results of the evaluation. strength and flexibility to ensure appropriate minutes to one hour requirement. Examples And a final reminder, adopting a functionality and a good quality of life. are household chores, physically active healthy lifestyle requires consistency and Researches reiterate over and over the commute, physically active recreational good habit formation. For people doing the challenges brought about by ageing, such activities, social and other forms of dancing, dance exercise-video, it is important to start as balance deficiencies, loss of strength, and and other forms of exercise such as yoga, tai- slow and adopt modest objectives. Make soft tissue stiffness. All these are alleviated chi and the like. progress only when the exercise becomes by appropriate physical activity and exercise. For most people, physical activity comfortable and easy. And at any point The dance-exercise video for and exercise promote health and wellness during the exercise, do not hesitate to stop older persons adopts movements that are benefits. However, it must also be recognized if dizziness, nausea, shortness of breath or simple and easy to follow. While it is only that for a small minority of population, it chest pains manifest. FACEbeat
Ibang Teknolohiya (Photo floating online)
44 HEALTHbeat I March - April 2012 bone HEALTH
Trigger Finger by DONATO DENNIS B. MAGAT HEALTHbeat Staff
DENNIS: Bakit pag umaga di ko maunat funny. In fact, the pain I had with my middle a snap — like a trigger being pulled and ang middle finger ko? Sobrang finger was so excruciating, especially in the released. If trigger finger is severe, the finger sakit! morning. may become locked in a bent position. The GLEN: Rayuma yan, pare. One of the most common hand condition is called trigger finger because PAKING: Sumpa yan, pare. Tingnan mo problems/injuries encountered today in when the finger unlocks, it pops back affected yung bad finger mo. orthopedic practice is trigger finger, also suddenly, as if releasing a trigger on a gun. It DENNIS: Mga loko! Bakit ba kinausap ko known as trigger digit. Trigger finger is is a common disorder, usually among adults, pa kayo. Wala naman pala ako medically termed Stenosing Tenosynovitis.It characterized by catching, snapping or mapapala sa inyo. is a "snapping" condition of any of the digits locking of the involved finger flexor tendon, of the hand when opened or closed. associated with dysfunction and pain. It isn’t the usual Healthbeat joke, One of the fingers gets stuck in Often painful, trigger finger causes so don’t be dismayed if you did not find it a bent position and then straightens with the fingers or thumb to catch or lock in a
March - April 2012 I HEALTHbeat 45 Data presented at the 2005 American College of Rheumatology National Meeting suggests that a majority of patients with rheumatoid arthritis have inflammation around the tendons of the palm of the hand that could develop into trigger finger. Also, prolonged, strenuous grasping may aggravate the condition. In the Philippines, there is no exact data on the number of affected Filipinos but Dr. Ryan Ruiz, chief resident of the JRRMMC Orthopedic Department, approximates that about 25-30 patients every month are seen at the JRRMMC. If left untreated, this may result/progress to pain or restrictive finger movement. Dr Jonathan Sabadao (second year hand resident, left) and Dr. Ryan Ruiz (chief resident, center) of He further explained that people the Jose R. Reyes Memorial Medical Center Orthopedic Department treat Dennis Magat (Healthbeat's whose occupation requires mostly the use managing editor, right) who is suffering from trigger finger. (Photo by Paking Repelente) of their hands are prone to develop trigger finger. Farmers, industrial workers, and bent position. The problems often stem with a substance called tenosynovium. The musicians are frequently affected by trigger from inflammation of tendons that are tenosynovium releases lubricating fluid that finger since they rely on their fingers or located within a protective covering called allows the tendon to glide smoothly within thumbs for multiple repetitive movements. the tendon sheath. People whose work or its protective sheath as the finger bends or The condition is more common in women hobbies require repetitive gripping actions straightens like a cord through a lubricated than in men with a frequency of 2-6 times are more susceptible. It is also more common pipe. and tends to occur most frequently in people in women and in anyone with diabetes. If the tenosynovium becomes who are between 40 and 60 years of age. The Dr. Melito Antonio Ramos, former inflamed frequently or for long periods, peak incidence of trigger finger is observed Vice Chair of the Jose R. Reyes Memorial the space within the tendon sheath can among individuals aged 55-60 years. Age Medical Center (JRRMMC) Orthopedic become narrow and constricting. The tendon distribution has not changed significantly Department, explains that trigger finger is a can't glide through the sheath easily, at despite repetitive tasks. condition that usually affects older persons. times catching the finger in a bent position Increased incidence of trigger He added that it occurs because before popping straight. With each catch, finger is observed in the dominant hand. there is a disparity in size between the flexor the tendon itself becomes more irritated The involvement of several fingers is not tendon and the surrounding retinacular and inflamed, worsening the problem. unusual. Triggering seems to occur more pulley system, commonly known as the A1 With prolonged inflammation, scarring and frequently in patients with rheumatoid pulley, resulting to difficulty in flexing or thickening (fibrosis) can occur and bumps arthritis or diabetes mellitus. These patients extending the finger and the “triggering” (nodules) can form in the affected finger/s. also seem to be more resistant to injection phenomenon. Diagnosis is made almost treatment. Basically, the cause of trigger exclusively by history and physical One of the first symptoms of finger is a narrowing of the sheath that examination alone. More than one finger trigger finger is soreness at the base of surrounds the tendon in the affected finger. may be affected at a time, though it usually the finger or thumb. The most common Tendons are fibrous cords that attach muscle affects the thumb, middle, or ring finger. The symptom is a painful clicking or snapping to bone. Each tendon is surrounded by a triggering is usually more pronounced in the when attempting to flex or extend the protective sheath — which, in turn, is lined morning, or while gripping an object firmly. affected finger. This catching sensation
46 HEALTHbeat I March - April 2012 tends to worsen after periods of inactivity step to recovery is to limit activities that regimen of physical therapy is generally and loosen up due to continuous movement. aggravate trigger finger, Sabadao explained. prescribed after the procedure, which may The signs and symptoms may Occasionally, a doctor may put a splint on the extend for two to six months. progress from mild to severe. These include: affected hand to restrict the joint movement. One recent study in the Journal finger stiffness, particularly in the morning, If symptoms continue, anti-inflammatory of Hand Surgery suggests that the most popping or clicking sensation as the finger/s medications may be prescribed. cost-effective treatment is two trials of is move, tenderness or a bump (nodule) An injection of steroid medication corticosteroid injection, followed by open at the base of the affected finger, finger may also be recommended into the tendon release of the first annular pulley. Choosing catching or locking in a bent position, which sheath. If the condition does not respond to surgery immediately is often not necessary suddenly pops straight, finger locked in a conservative measures or consistently recurs, for resolution of symptoms. bent position, which becomes unable to surgery may be recommended to release More recently, a randomized straighten. the tendon sheath and restore movement. controlled trial comparing corticosteroid Dr. Jonathan Sabadao, second- Stretching, ice, and anti-inflammation injection with needle release and open year hand resident also of JRRMMC treatments can be helpful. release of the A1 pulley reported that only Orthopedic Department, explained that The most rapidly effective 57% of patients responded to corticosteroid the key to prevention is education, proper treatment is a local cortisone injection injection (defined as being free of triggering biomechanics, and common knowledge. around the affected tendon and most symptoms for greater than 6 months). This is The common mistake of trying to work patients responds to this type of treatment. compared to a percutaneous needle release through the pain over use of the finger must However, if the condition persists after two (100% success rate) and open release be avoided. When dealt with trigger finger injections, surgical procedure to ultimately (100% success rate). There is a theoretical symptoms, address it conservatively by short remove the inflamed or scarred tissue is greater risk of nerve damage associated exercises during stressful work at home, considered. with the percutaneous needle release as the massage, resting and soaking finger in tepid The recovery time differs from technique is performed without seeing the water is effective and are good preventive every individual and depends on the severity A1 pulley. measures. When symptoms persist, see your of the condition. The choice of treatment Other investigative treatment physician. also impacts recovery time. However, most options with limited scientific support No x-rays or lab tests are used patients with trigger finger recover within include non-steroidal anti-inflammatory to diagnose trigger finger. It is generally a few weeks by resting and limiting the use drugs, occupational or physical therapy, diagnosed following a physical exam of the of the affected finger and/or using anti- steroid treatment, splinting, therapeutic hand and fingers. In some cases, the affected inflammatory medications. ultrasound with anti-inflammatory cream finger may be swollen and there may be a Injection of the tendon sheath and acupuncture. nodule, or bump, over the joint in the palm with a corticosteroid is effective over weeks Sabadao also suggests that people of the hand. The finger may also be locked in to months in more than half of patients with trigger finger should immediately a flexed (bent) position, or it may be stiff and treated. When corticosteroid injection fails, consult a health professional as this may painful. the problem is predictably resolved by a limit one’s performance of daily tasks or “Treatment of trigger finger relatively simple surgical procedure (usually even productivity at the workplace. varies depending on the severity. The first outpatient, under local anesthesia). A - o O o - Oki, Dok! ED: Pare, alam mo ba kung bakit nagsusuot ng gloves ang mga duktor at nars bago mag-opera? RAUL: 'Pre, kasi kung mamatay ang pasyente, walang makukuhang fingerprints!
March - April 2012 I HEALTHbeat 47 fashion DOCTOR
The "Crack Epidemic"
“Exposure” showing their entire midriff including the fall out of favor in 2008 and have become less belly button. common since, although they still remain A fit and healthy body exudes This fashion statement escalates somewhat popular. In the Philippines, it confidence in carrying any type of clothing, to the “crack epidemic” where low-rise is still very much in fashion especially for from the relaxed jeans and t-shirt to the jeans partially reveal the buttocks when young people. However, paraphrasing the most formal barong or coat and tie for men the wearer sits down or bends over. In many tourism campaign, wearing low-rise jeans and dinner dress or gown for women. And so cases, butt cleavage becomes visible. is “more funny in the Philippines” especially the old fashion maxim goes, “if you have it, In some cases, it is the designer or for the modest Filipinos. Instead of flaunting flaunt it.” branded underwear that is flaunted. When their butt crack, they keep on pulling their But what if you don’t have that a thong is exposed above a pair of low-rise shirts or blouses down or cover their back kind of body, and what you got is a beer jeans on the back, it is commonly referred to with their hands when they sit or bend over. belly or a coca cola body (coke in can, that as a "whale tail," due to its somewhat similar Wearing these jeans is like putting their hips is) instead of a six-pack abs or a curvaceous shape. When boxer shorts become visible and buttocks in some humiliating way. body. Would you still wear the trendiest this is known as "sagging" or "sagg". fashion? A Facebook post posing as a "public “Etiology” On the street, on television, in the service announcement" that is recently mall and even in the office, women (and circulating, discourages people from wearing Low-rise jeans are not new fashion. men too) of all ages and sizes are wearing low-rise jeans. It says that this fashion trend The style dates back to the late 1960s with tight, low-slung, butt-hugging jeans and was born in the United States' jails where the ascendance of the hippie counterculture pants that hit at, or often far below, the hip. prisoners who were willing to have sex with and rock 'n' roll, and was referred to as hip- Low-rise jeans are worn to display more skin other prisoners needed to invent a signal by huggers. Rock icons like Jimi Hendrix, Janis at the waist, torso, and hips. Accordingly, partially showing their butts and that they Joplin and Jim Morrison popularized it. Later, they are sometimes worn in combination were available to be penetrated. (See image hip-huggers became a staple of popular with shorter crop tops, giving a glimpse next page.) culture and were incorporated into the disco of skin between the jeans and the top, or In the US, low-rise jeans are said to scene of the 1970s. However, waistlines
48 HEALTHbeat I March - April 2012 moved higher in the 1980s and 1990s, shoelace, abandon all hope because bending permanent. This condition was diagnosed as more women entered the corporate over with dignity is next to impossible. in three mildly obese women who had worn workforce. You must perfect the art of squatting, back low-rise jeans for 6–8 months. It resolved The revival of low-rise jeans can straight and head up. These jeans also tend itself after they avoided wearing low-rise be credited to British designer Alexander to slide down, requiring the wearer to hitch jeans for 4–6 weeks. McQueen, who first showed his famous low- them up repeatedly. Likewise, back pain may also occur. rise "bumster" trousers in his 1996 "Dante" You may look nice with those low- Wearing too tight low-rise jeans compresses collection show. And the style became rise jeans or any other skinny outfits for a day the back muscles causing pain. You will know popular again in the US, particularly among but in a long run, you have no idea about the if your pants squeeze your waist badly when the youth, when Britney Spears started effects of wearing skin tight clothes. Take taking a seat. Again, tingling in the area may wearing it in 2000. a look to know how tight clothes impacts occur. To prevent this, when choosing a pair In 2004 and 2005, at least two US health. of jeans, try it and see to it that it does not legislators tried to outlaw low-rise jeans, In 2003, the Canadian Medical shrink your body when you squat. particularly the display of underwear under Association Journal published a report by Then, there is the possibility of the pants, claiming it to be disrespectful and Dr.Malvinder S. Parmar stating that low- yeast infection. When women’s pubic areas obscene. Their bills were eventually rejected. rise jeans can cause a condition called are kept tightly under wraps, the area Now, low-rise jeans are worn meralgiaparesthetica. It is characterized becomes very warm and moist. This makes by both men and women. The jeans are by numbness or tingling in the thighs, by it a breeding ground for bacteria and, as intended to sit low on, or below, the hips. pinching a nerve located at the hip. Left a result, can cause yeast infections. The Usually they sit at least 8 centimetres (3 untreated, the numbness can become vaginal area becomes very itchy, irritating inches) lower than the belly button. and painful. To avoid this, especially But in several styles, the rise has in hot weather, avoid wearing tight dipped as low as 3 or 4 inches. pants. Instead, wear sundresses, The "rise" of any jeans loose fitting and breezy pants. is determined by the distance Finally, there is heartburn, between the crotch and the abdominal pain and even waist and is usually around 30 constipation. The tight pressure centimeters or cm (12 inches) on on the stomach and the abdomen regular pants. In comparison, the leads to pain. It may cause an acid average measurement of low-rise reflux resulting in severe burning jeans is roughly 20 cm (8 inches). sensation. Tight pants can also But in several styles, the rise has slow down the digestive process. dipped as low as 7-10 cm (3-4 The symptoms may include bitter inches). taste in the mouth, pain below the waist, pain in the abdomen for two “Emergency” to three hours after eating a meal. It is important to eat smaller meals The real problem with and make sure the belt and pants extremely low-rise jeans is that are not too tight. Or better yet, they are impractical. Sitting is unbutton your pants and change it difficult: If you cannot find a chair immediately. Drink water and wear with a closed back, you may have a loose outfit. to tie a shirt around the waist or In the final analysis, clothes risk scandalizing the room. If you should be made for comfort. drop something, or need to tie a (A Facebook post discouraging people to wear low-rise jeans. ) - o O o -
March - April 2012 I HEALTHbeat 49 SAbeat Gusto Mong Away?
Away BFF Away Matanda
Nagkasulutan ng boyfriend ang dalawang LYNDON: Dok! Dok! Nawala ang BFF (Best Friends Forever)... memorya ko! LIBBY: Anong pangarap mo? DOK: Huminahon po kayo, lolo. WENA: Bakit friendship?!? Kailan po nangyari ito? LIBBY: Sisirain ko! LYNDON: (Nagtataka) Kailan nangyari ang ano? Away Beki Away Bansa NEIL: Sana mamatay na lahat ng malalandi sa mundo! MANNY: Tayong dalawa, para tayong BRYAN: Bakit may pera ka na bang Away Mag-ama Pilipinas at Spratlys. pampalibing mo? MARIVIC: Bakit naman? JOJO: Joshua! Kinuha mo ang pera sa MANNY: Kasi kahit gaano kalapit natin sa Away Mag-asawa bulsa ng pantalon ko 'no? isa't isa, hindi ko pa rin masabing JOSHUA: Anong sabi mo 'Tay?!? ikaw ay akin. JUDGE: Ano ang dahilan para kayo JOJO: Ang sabi ko, kinuha mo 'yung magpa-annul? pera sa bulsa ng pantalon ko! Away Mahirap JOAN: (Nagsalita habang nakayuko) Your JOSHUA: 'Di ko talaga marinig 'Tay. honor, katawan lang ang gusto Kung gusto mo palit tayo ng ERNIE: Pahingi naman ng pinya... niya sa akin. pwesto. Dito ka at ako naman FRANK: Pahingi? Nasaan ka noong JUDGE: At ano naman ang prueba mo? ang magtatanong d'yan. nagbubungkal ako ng lupa JOAN: (Nakayuko pa rin) Tuwing JOJO: Sige, subukan natin. sa ilalim ng init ng araw? Nasaan nagsisiping po kami, tinatakpan JOSHUA: Sinong babae 'yung kasama mo ka nung binabantayan ko ang niya ng towel ang mukha ko. kanina? mga pananim habang JUDGE: Ikaw Mister bakit mo ginawa yun? JOJO: Ay, oo nga! 'Di nga marinig. kumukulog, kumikidlat at MARIO: No comment, your honor. Just see bumubuhos ang malakas na ulan? for yourself. Away Dambuhala Nasaan ka nung nag-aani ako na JOAN: (Nagalit at ihinarap ang mukha sa nagkalat ang mga ahas sa daanan Judge) Bastos po talaga ang 'yan! PRESCY: Taba, taba, magkano baboy ko? Nasan ka nung naghihirap ako JUDGE : (Habang nakatingin kay Misis) ngayon?!? sa pagpasan ng pinya? Nasaan ka? Annulment petition granted. Ikaw BAMBI: Hoy! Ayusin mo yang ERNIE: Nakakulong kasi ako noon! naman lalaki, bakit ngayon ka pananalita mo ha! Nakapatay ako ng madamot! lang nag-file ng annulment? Ang PRESCY: Baboy, baboy, magkano taba FRANK: Ganun ba? Kuha ka na, kahit ilan! tiyaga mo rin! ngayon?!? Hahaha. May langka pa doon!
50 HEALTHbeat I March - April 2012